Transcript Modeling Studies in AIDS Vaccine R&D

Modeling Studies in AIDS Vaccine R&D
Arne Naeveke
Executive Director Advocacy, Policy and Communications
IAEN – AIDS 2014 Pre-conference – July 19, 2014, Melbourne, Australia
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Our objectives for modeling in AIDS vaccine R&D
• Demonstrate the impact of an AIDS vaccine in accelerating
progress in the global HIV response
• Quantify the influence of different product characteristics on
the impact and cost-effectiveness of an AIDS vaccine
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Major Obstacles to ‘Getting to Zero’ Persist
• There are still 2.1M new infections every year (2013)
• Rates are still growing in specific populations and regions
• Access, enrollment and adherence to available prevention and
treatment remains challenging for specific populations and regions
• Annual funding in LICs/MICs is currently falling $3-5B short of the
$22-24B needed to fully scale up existing tools (2013)
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A Vaccine Is Needed to “Get Close to Zero”
New HIV Infections
Cumulative
infections
avoided
2011-50
22.5M
16.0M
7.4M
* An illustrative vaccine with an assumed efficacy of
60%, not representative of any specific candidate in
development. Coverage reaches 70% in generalized
HIV/AIDS epidemics, 60% in concentrated epidemics.
Potential impact of an AIDS vaccine as part of the UNAIDS Enhanced Investment Framework, IFE
Modeling project – UNAIDS, Futures Institute, IAVI, AVAC [funded by USAID]
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A Vaccine Used in Combination with Other NPTs
Achieves Most Dramatic and Quickest Impact
New HIV Infections – NPTs added to full scale up of
Investment Framework Enhanced (IFE)
2,200,000
2,000,000
1,200,000
1,000,000
IFE
800,000
IFE + Treatment as
Prevention
600,000
IFE + Pre-exposure
Prophylaxis
400,000
IFE + Vaccine
200,000
IFE + Combination
0
2011
2016
2021
2026
2031
2036
2041
2046
Vaccine efficacy 60% and vaccination coverage 70%/60% in generalized/concentrated epidemics
Modeling project – UNAIDS, Futures Institute, IAVI, AVAC [funded by USAID]
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The Impact of a Vaccine Will Be Highly Dependent
on Its Efficacy
New infections at varying vaccine efficacy levels – IFE full scale-up
2,200,000
2,000,000
800,000
600,000
IFE
400,000
30%
40%
50%
200,000
60%
80%
0
2011
2016
2021
2026
2031
2036
2041
2046
Vaccination coverage reaches 70%/60% in generalized/concentrated HIV/AIDS epidemics
Modeling project – UNAIDS, Futures Institute, IAVI, AVAC [funded by USAID]
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Total Cost Per Regimen will be Key to Achieving
Cost-effectiveness in LICs and Lower MICs
Cost ($)/QALY saved
Cost($)/QALY
14,000
IFE
12,000
50% scale-up
10,000
8,000
6,000
4,000
3800
2,000
1200
Lower MICs
LICs
0
$100
$67.50
$37.50
$20
-2,000
Cost per regimen
Vaccine efficacy 60% and vaccination coverage 70%/60% in generalized/concentrated epidemics.
CE definitions and categories from according to the Word Development Indicators (WDI) of the World Bank.
Modeling project – UNAIDS, Futures Institute, IAVI, AVAC [funded by USAID]
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Lower Cost Per Regimen is Even More Important at
Lower Efficacy Levels
Cost ($)/QALY saved compared to IFE
Cost($)/QALY
25,000
40% Vaccine Efficacy
20,000
60% Vaccine Efficacy
15,000
80% Vaccine Efficacy
10,000
5,000
3800
Lower MICs
1200
LICs
0
$100
$67.50
$37.50
$20
Cost per regimen
Vaccination coverage 70%/60% in generalized/concentrated epidemics.
CE definitions and categories according to the Word Development Indicators (WDI) of the World Bank.
Modeling project – UNAIDS, Futures Institute, IAVI, AVAC [funded by USAID]
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Preliminary Conclusions from Impact Modeling
• An AIDS vaccine is needed in combination with other prevention approaches
to truly achieve and sustain the end of AIDS
• A modestly effective vaccine does reduce new infections significantly, but a
highly effective vaccine is needed to get “close to zero” and to provide the
cost-effectiveness needed to support broad access
• Cost per regimen is a critical factor to achieve acceptable cost-effectiveness
in low and middle income countries, particularly at lower efficacy levels
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Next steps
• Refine and finalize cost per regimen assumptions
• “Stress-test” coverage assumptions
• Complete calculations of the influence of variables on impact
and cost-effectiveness
• Further update as the epidemic and the response evolve
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