Modeling Studies in AIDS Vaccine R&D 1 Arne Naeveke Executive Director Advocacy, Policy and...
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Transcript of Modeling Studies in AIDS Vaccine R&D 1 Arne Naeveke Executive Director Advocacy, Policy and...
Modeling Studies in AIDS Vaccine R&D
1
Arne NaevekeExecutive Director Advocacy, Policy and Communications
IAEN – AIDS 2014 Pre-conference – July 19, 2014, Melbourne, Australia
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”
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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22.5M
16.0M
7.4M
Cumulativeinfectionsavoided2011-50
New
HIV
Infe
ction
s
* 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.
2,000,000
2,200,000
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A Vaccine Used in Combination with Other NPTs Achieves Most Dramatic and Quickest Impact
Modeling project – UNAIDS, Futures Institute, IAVI, AVAC [funded by USAID]
Vaccine efficacy 60% and vaccination coverage 70%/60% in generalized/concentrated epidemics
New HIV Infections – NPTs added to full scale up of Investment Framework Enhanced (IFE)
0
200,000
400,000
600,000
800,000
1,000,000
1,200,000
IFE
IFE + Treatment as Prevention
IFE + Pre-exposure Prophylaxis
IFE + Vaccine
IFE + Combination
The Impact of a Vaccine Will Be Highly Dependent on Its Efficacy
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Modeling project – UNAIDS, Futures Institute, IAVI, AVAC [funded by USAID]
Vaccination coverage reaches 70%/60% in generalized/concentrated HIV/AIDS epidemics
0
200,000
400,000
600,000
800,000
IFE
30%
40%
50%
60%
80%
Se-ries7
2,000,000
2,200,000New infections at varying vaccine efficacy levels – IFE full scale-up
$100 $68 $38 $20
-2,000
0
2,000
4,000
6,000
8,000
10,000
12,000
14,000
Cost ($)/QALY saved
IFE 50% scale-up
Cost per regimen
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Total Cost Per Regimen will be Key to Achieving Cost-effectiveness in LICs and Lower MICs
Cost($)/QALY
1200
3800Lower MICs
LICs
Modeling project – UNAIDS, Futures Institute, IAVI, AVAC [funded by USAID]
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.
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Lower Cost Per Regimen is Even More Important at Lower Efficacy Levels
$100 $68 $38 $20 0
5,000
10,000
15,000
20,000
25,000
Cost ($)/QALY saved compared to IFE
40% Vaccine Efficacy
60% Vaccine Efficacy
80% Vaccine Efficacy
Cost per regimen
Cost($)/QALY
1200
3800Lower MICs
LICs
Modeling project – UNAIDS, Futures Institute, IAVI, AVAC [funded by USAID]
Vaccination coverage 70%/60% in generalized/concentrated epidemics.CE definitions and categories according to the Word Development Indicators (WDI) of the World Bank.
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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