Pharmacoeconomic perspectives on HIV: integrating data for long-term treatment and prevention

Sustained progress against HIV has been enabled largely by antiretroviral therapy (ART), yet gaps in prevention, treatment coverage, and financing continue to threaten long-term control of the epidemic. Pharmacoeconomics provides a crucial framework for identifying interventions that deliver the greatest health gains per dollar spent, particularly in resource-limited settings where HIV programs must balance lifelong treatment needs with expanding prevention options. Economic evaluations consistently show that high-impact interventions such as dolutegravir-based ART, targeted PrEP delivery, and voluntary medical male circumcision often fall within favorable cost-effectiveness thresholds, with typical incremental cost-effectiveness ratios (ICERs) ranging from as low as US $245 per DALY averted for PrEP in serodiscordant couples to US $174-2,800 per infection averted for VMMC. This review synthesizes the pharmacoeconomic evidence across treatment and prevention, highlights the value of integrating real-world costs and equity considerations, and underscores the need for robust, context-specific economic models to support sustainable HIV responses. Achieving long-term epidemic control will depend on addressing persistent indirect costs, improving access for marginalized populations, and aligning investments with interventions that demonstrate both clinical effectiveness and compelling economic value.