Modeling Studies in AIDS Vaccine R&D

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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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