Would you drop $10,000 a year to stop yourself from getting HIV?

Thanks to advances in fighting HIV/AIDS over the last decades, these diseases are no longer the death sentences they once were — and some drugs offer the chance to protect against infection in the first place. Considering the huge price associated with these pills, would it make sense to do so? And for whom?

The drug tenofovir-emtricitabine (sold as Truvada) costs $26 a day to take, which adds up mighty quickly, but if taken correctly, it can mean a 73% drop in risk of acquiring HIV. And according to a new study out of Stanford, forking out almost $10,000 a year for this prescription could make sense — but only for a very specific sub-section of the population: high-risk gay men.

According to the study, men who have sex with men are still at the highest risk of HIV infection, and account for more than half of the 56,000 new cases that arrive annually. Getting the entire American population of gay/bi sexually-active men on the pill would cost a truly stupefying amount, $495 billion over 20 years. However, with a few caveats in play, the researchers think there's a way to have this make financial sense.

For one, they suggest that only at-risk men engage in pre-exposure prophylaxis, or PrEP — those who have five or more sexual partners a year. If 20% of those people took the pill, that would lead to a drop of 41,000 cases for a cost of $16.6 billion. That's a bill of $1,185,714.29 per case, which seems still rather a lot of money, but apparently amounts to "$50,000 per quality-adjusted life year gained (a measure of how long people live and their quality of life)"

But this doesn't really seem to answer a great many of questions that have been raised. PrEP has been studied extensively, and previous economic analyses have given it a higher pricetag — which this study avoided by limiting it to 20 years of pill taking. It also doesn't answer who would pay for this, since $10,000 a year is a huge financial burden for something prophylactic — and I'd be curious if an insurance company would crunch those numbers in the same way and consider it financially feasible.

You also have to wonder if there aren't other population groups who might also be interested in this. Sex workers, perhaps? Doctors who work in clinics with at risk populations, who are constantly terrified of being accidentally stuck with a surgical needle? And how does it compare to post-exposure prophylaxis?

But by far the biggest elephant in the room is that you're asking a significant body of people to use a drug with potent side effects for a major part of their adult lives, one which causes kidney problems and a laundry list of other issues. Not to mention the places where these drugs would really be needed — sub-Saharan Africa and parts of Asia — are the same that would have the most trouble in paying that amount.

With the announcement of the report, the drug's maker Gilead Sciences Inc., has already filed a supplemental new drug application to market it for prevention purposes.

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