Cost-effectiveness and Public-Health Impact of Cabotegravir Long-Acting Injectable P264 for HIV Pre-exposure Prophylaxis in Canada

Sep 27, 2026

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Cabotegravir long-acting (CAB-LA) administered every two months is evaluated for HIV pre-exposure prophylaxis in Canada against daily oral tenofovir disoproxil fumarate/emtricitabine (TDF/FTC) and no PrEP. A decision-analytic Markov model estimates lifetime clinical and economic impacts from a Canadian public payer perspective, using indirect treatment comparison results integrating HPTN 083 and 084. CAB-LA is modeled as less costly ($174,847) and more effective (36.86 QALYs) than TDF/FTC ($192,328; 36.67 QALYs) and no PrEP ($261,682; 36.29 QALYs), preventing more primary and secondary HIV infections. NNT to prevent one primary infection is 13 for CAB-LA versus 19 for TDF/FTC compared with no PrEP, implying about 37 switches to avoid one additional infection.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages2

Reading Time5 min

AccessFree to download

Key Takeaways

Introduction

PrEP background and need in Canada

Approval and study evidence for CAB-LA

Objective

Methods

Markov model and treatment pathway

Indirect treatment comparison and outcomes

Model inputs and assumptions

Population, incidence, and effectiveness parameters

Cost-effectiveness and Public-Health Impact of Cabotegravir Long-Acting Injectable P264 for HIV Pre-exposure Prophylaxis in Canada Adenike R. Adelakun, 1 Michael Dolph,2 Emily Matthews,2 Alan Oglesby,3 Kelly Campbell,4 Ashley Davis,5 Janine Xu, 1 Isabelle Hardy,6 Natalya Danchenko,7 Sarah-Jane Anderson7 1 GlaxoSmithKline Inc., Mississauga, Canada; 2 Cytel Inc., Toronto, Canada; 3 ViiV Healthcare, Durham, USA; 4 RTI Health Solutions, Manchester, UK, 5 RTI Health Solutions, Durham, USA; 6 ViiV Healthcare ULC, Montreal, Canada; 7 ViiV Healthcare, London, UK Key Takeaways ● Cabotegravir long-acting (CAB-LA) injectable administered every 2 months is superior to daily tenofovir disoproxil fumarate/emtricitabine (TDF/FTC) for HIV-1 pre-exposure prophylaxis (PrEP) . ● CAB-LA was less costly ($174,847) and more effective (36.86 QALYs) than TDF/FTC ($192,328; 36.67 QALYs) and no PrEP ($261,682; 36.29 QALYs) and prevented more primary and secondary HIV-1 infections than daily oral TDF/FTC and no PrEP. ● The number needed to treat (NNT) to prevent one primary HIV infection over the modelled time horizon was 13 for CAB-LA and 19 for TDF/FTC compared with No PrEP. ● On average, 37 people need to switch from TDF/FTC to CAB-LA to avoid one additional HIV infection. ● CAB-LA as PrEP in Canada offers public health and economic benefits by preventing additional HIV infections and reducing the clinical and economic burden of HIV. Introduction • By the end of 2022, ~65,270 persons were living with HIV in Canada. 1 • In 2022, 5 people acquired HIV each day in Canada. HIV incidence increased by 24.9% between 2021 and 2022, and 15% between 2020 and 2022. 1,2 • New HIV acquisition rates differ by exposure categories, sex, and Canadian jurisdictions. 1,2 • HIV pre-exposure prophylaxis (PrEP) has been demonstrated to prevent HIV acquisition in individuals who do not have HIV but are at increased risk of infection.3,4 • 98% of PrEP users in Canada in 2022 were male.5 • Despite being available in Canada for 8 years, daily oral PrEP, tenofovir disoproxil fumarate/emtricitabine (TDF/FTC) is underutilized by at risk individuals.6 High levels of adherence are required for PrEP to be effective.6 • Cabotegravir long-acting (CAB-LA) injectable, the first long-acting injectable, administered every two months was approved in Canada (May 2024) as PrEP to reduce the risk of sexually acquired HIV-1 infection in at-risk adults and adolescents, including men who have sex with men (MSM), transgender women (TGW), and cisgender women (CGW) . • The HIV Prevention Trials Network (HPTN) 083 (MSM and TGW) and HPTN 084 (CGW) studies demonstrated the superiority of every two months CAB-LA versus the standard of care, TDF/FTC for HIV-1 PrEP. 3,4 • Objective: To estimate the lifetime clinical and economic impact of CAB-LA compared with oral TDF/FTC and no PrEP from a Canadian public payer perspective. Methods • A decision-analytic Markov model was used to evaluate the treatment pathway and capture the expected clinically important differences in costs and outcomes between patients receiving every two months CAB-LA versus daily oral TDF/FTC or no PrEP. • The model is an adaptation of the recently published costeffectiveness analysis performed for the US context, and has a similar underlying structure, but has been further adapted to allow for incorporation of the results of an Indirect Treatment Comparison (ITC) study.7,8 • In base case, modelled individuals initiated a PrEP option (CAB-LA or TDF/FTC) or no PrEP upon model entry and continued to receive their initially assigned PrEP option until discontinuation, HIV acquisition, or death. • Number needed to treat (NNT) was estimated for PrEP compared with no PrEP and for CAB-LA compared with TDF/FTC. Figure 1. Model Structure • An ITC including the HPTN 083 and 084 studies provided an estimate of the effectiveness of CAB-LA vs. no PrEP based on the observed effectiveness of C

FAQs

What treatment options does the model compare for HIV PrEP in Canada?

The analysis compares every two months cabotegravir long-acting (CAB-LA) injectable with daily oral TDF/FTC and with no PrEP, over a lifetime horizon.

What are the key cost and effectiveness results for CAB-LA versus TDF/FTC and no PrEP?

CAB-LA is modeled as less costly ($174,847) and more effective (36.86 QALYs) than TDF/FTC ($192,328; 36.67 QALYs) and no PrEP ($261,682; 36.29 QALYs). It also prevents more primary and secondary HIV-1 infections than the comparators.

How do the NNT findings describe the impact of switching to CAB-LA?

The number needed to treat (NNT) to prevent one primary HIV infection is 13 for CAB-LA and 19 for TDF/FTC compared with no PrEP. On average, 37 people need to switch from TDF/FTC to CAB-LA to avoid one additional HIV infection.

Sep 27, 2026

Uploaded by Blitz