Health Gains and Cost-Effectiveness of Cabotegravir Long-Acting HIV Pre-Exposure Prophylaxis (PrEP): A Systematic Review
1
Medical Laboratory Services, University of Calabar Teaching Hospital (UCTH), Calabar, Nigeria
2
Department of Medicine and Surgery, College of Medicine, University of Ibadan, Ibadan, Nigeria
3
Department of Public Health, University of Calabar, Calabar, Nigeria
4
Department of Chemical Pathology, Babcock University Teaching Hospital, Ilishan-Remo, Nigeria
5
School of Nursing, University of Ghana, Accra, Ghana
6
Department of Community Engagement and Social Sciences, Rinda Ubuzima, Kigali, Rwanda
7
Department of Health Policy and Management, College of Medicine, University of Ibadan, Ibadan, Nigeria
8
Department of Chemical Pathology, Faculty of Basic Clinical Sciences, University of Calabar, Calabar, Nigeria
Popul. Med. 2026;8(Supplement Supplement 1):A3087
ABSTRACT
INTRODUCTION:
Cabotegravir long-acting injectable (CAB-LA) is a promising PrEP for HIV prevention, especially for populations with poor adherence to daily oral PrEP. This study systematically reviewed studies on CAB-LA cost-effectiveness as PrEP.
METHODS:
We searched PubMed, Scopus, Web of Science, Embase and the Cochrane Library for modelling studies from 2015 to 2025 assessing CAB-LA cost-effectiveness versus oral PrEP or no PrEP. Eligible studies reported economic outcomes including incremental cost-effectiveness ratios (ICERs), cost per HIV infection averted, or cost per quality-adjusted life year QALY or disability-adjusted life year (DALY) gained. Risk of bias was assessed using the CHEERS 2022 checklist. Results were narratively synthesized due to heterogeneity.
RESULTS:
Eleven modelling studies across sub-Saharan Africa, the United States, and Asia-Pacific regions showed that the magnitude of benefit of CAB-lA varied by setting, population, and implementation strategy. Overall, CAB-LA was associated with meaningful reductions in new transmissions, HIV-related deaths, and disability-adjusted life-years (DALYs) lost. In South Africa, CAB-LA reduced the lifetime risk of HIV transmission among high-risk women to 510 per 1000 compared to 540 per 1000 with oral PrEP and 630 per 1000 with no PrEP, corresponding to a 19% reduction relative to no PrEP and 6% relative to oral PrEP. Across models, CAB-LA drug price, HIV incidence, ART coverage, adherence and persistence, and delivery scale were the most influential parameters affecting cost-effectiveness. Drug price was the dominant determinant of cost-effectiveness across all studies. In Africa, it was cost-effective at $60 - $80 per year and cost-saving at $65. In contrast, U.S and Asian models found it not cost-effective at current prices which requires 24% to 88% price reductions.
CONCLUSIONS:
CAB-LA is clinically superior but economically viable only at reduced prices and in high-risk populations. Wider adoption requires price negotiations and equitable implementation to ensure affordability and maximize health impact.
Cabotegravir long-acting injectable (CAB-LA) is a promising PrEP for HIV prevention, especially for populations with poor adherence to daily oral PrEP. This study systematically reviewed studies on CAB-LA cost-effectiveness as PrEP.
METHODS:
We searched PubMed, Scopus, Web of Science, Embase and the Cochrane Library for modelling studies from 2015 to 2025 assessing CAB-LA cost-effectiveness versus oral PrEP or no PrEP. Eligible studies reported economic outcomes including incremental cost-effectiveness ratios (ICERs), cost per HIV infection averted, or cost per quality-adjusted life year QALY or disability-adjusted life year (DALY) gained. Risk of bias was assessed using the CHEERS 2022 checklist. Results were narratively synthesized due to heterogeneity.
RESULTS:
Eleven modelling studies across sub-Saharan Africa, the United States, and Asia-Pacific regions showed that the magnitude of benefit of CAB-lA varied by setting, population, and implementation strategy. Overall, CAB-LA was associated with meaningful reductions in new transmissions, HIV-related deaths, and disability-adjusted life-years (DALYs) lost. In South Africa, CAB-LA reduced the lifetime risk of HIV transmission among high-risk women to 510 per 1000 compared to 540 per 1000 with oral PrEP and 630 per 1000 with no PrEP, corresponding to a 19% reduction relative to no PrEP and 6% relative to oral PrEP. Across models, CAB-LA drug price, HIV incidence, ART coverage, adherence and persistence, and delivery scale were the most influential parameters affecting cost-effectiveness. Drug price was the dominant determinant of cost-effectiveness across all studies. In Africa, it was cost-effective at $60 - $80 per year and cost-saving at $65. In contrast, U.S and Asian models found it not cost-effective at current prices which requires 24% to 88% price reductions.
CONCLUSIONS:
CAB-LA is clinically superior but economically viable only at reduced prices and in high-risk populations. Wider adoption requires price negotiations and equitable implementation to ensure affordability and maximize health impact.
| eISSN: | 2654-1459 |
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