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Once available, HIV vaccines will be an important complement but also potential competitor to other biomedical prevention tools such as pre\u2010exposure prophylaxis (PrEP). Accordingly, the value of HIV vaccines and the policies for rollout may depend on that interplay and tradeoffs with utilization of existing products. In this economic modelling analysis, we estimate the cost\u2010effectiveness of HIV vaccines considering their potential interaction with PrEP and condom use.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We developed a dynamic model of HIV transmission among the men who have sex with men population (MSM), aged 15\u201064\u00a0years, in Seattle, WA offered PrEP and HIV vaccine over a time horizon of 2025\u20102045. A healthcare sector perspective with annual discount rate of 3% for costs (2017 USD) and quality\u2010adjusted life years (QALYs) was used. The primary economic endpoint is the incremental cost\u2010effectiveness ratio (ICER) when compared to no HIV vaccine availability.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>HIV vaccines improved population health and increased healthcare costs. Vaccination campaigns achieving 90% coverage of high\u2010risk men and 60% coverage of other men within five years of introduction are projected to avoid 40% of new HIV infections between 2025 and 2045. This increased total healthcare costs by $30 million, with some PrEP costs shifted to HIV vaccine spending. HIV vaccines are estimated to have an ICER of $42,473\/QALY, considered cost\u2010effective using a threshold of $150,000\/QALY. Results were most sensitive to HIV vaccine efficacy and future changes in the cost of PrEP drugs. Sensitivity analysis found ranges of 30\u201070% HIV vaccine efficacy remained cost\u2010effective. Results were also sensitive to reductions in condom use among PrEP and vaccine users.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Access to an HIV vaccine is desirable as it could increase the overall effectiveness of combination HIV prevention efforts and improve population health. Planning for the rollout and scale\u2010up of HIV vaccines should carefully consider the design of policies that guide interactions between vaccine and PrEP utilization and potential competition.<\/jats:p><\/jats:sec>","DOI":"10.1002\/jia2.25373","type":"journal-article","created":{"date-parts":[[2019,8,12]],"date-time":"2019-08-12T06:15:26Z","timestamp":1565590526000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":16,"title":["Competing biomedical HIV prevention strategies: potential cost\u2010effectiveness of HIV vaccines and PrEP in Seattle, WA"],"prefix":"10.1002","volume":"22","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4251-2912","authenticated-orcid":false,"given":"Blythe","family":"Adamson","sequence":"first","affiliation":[{"name":"Department of Pharmacy The Comparative Health Outcomes, Policy, and Economics (CHOICE) Institute University of Washington Seattle WA USA"},{"name":"Vaccine and Infectious Diseases Division Fred Hutchinson Cancer Research Center Seattle WA USA"},{"name":"Flatiron Health New York NY USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Louis","family":"Garrison","sequence":"additional","affiliation":[{"name":"Department of Pharmacy The Comparative Health Outcomes, Policy, and Economics (CHOICE) Institute University of Washington Seattle WA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ruanne V","family":"Barnabas","sequence":"additional","affiliation":[{"name":"Vaccine and Infectious Diseases Division Fred Hutchinson Cancer Research Center Seattle WA USA"},{"name":"Division of Allergy and Infectious Diseases Department of Global Health University of Washington Seattle WA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Josh J","family":"Carlson","sequence":"additional","affiliation":[{"name":"Department of Pharmacy The Comparative Health Outcomes, Policy, and Economics (CHOICE) Institute University of Washington Seattle WA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James","family":"Kublin","sequence":"additional","affiliation":[{"name":"Division of Allergy and Infectious Diseases Department of Global Health University of Washington Seattle WA USA"},{"name":"HIV Vaccine Trials Network Fred Hutchinson Cancer Research Center Seattle WA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dobromir","family":"Dimitrov","sequence":"additional","affiliation":[{"name":"Vaccine and Infectious Diseases Division Fred Hutchinson Cancer Research Center Seattle WA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2019,8,11]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMp1313771"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2017.13505"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.2807\/1560-7917.ES.2017.22.42.17-00192"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.7326\/M15-2634"},{"key":"e_1_2_9_6_1","volume-title":"HIV\/AIDS epidemiology report 2015","author":"HIV\/AIDS Epidemiology Unit Public Health \u2013 Seattle & King County and the Infectious Disease Assessment Unit Washington State Department of Health","year":"2015"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.1097\/OLQ.0b013e3181a9cc41"},{"key":"e_1_2_9_8_1","volume-title":"Preexposure prophylaxis for the prevention of HIV infection in the United States \u2013 2014: a clinical practice guideline","author":"US Public Health Service","year":"2014"},{"key":"e_1_2_9_9_1","volume-title":"Pre\u2010exposure prophylaxis (PrEP) implementation guidelines 2015","author":"Public Health \u2013 Seattle & King County WSD of H","year":"2015"},{"key":"e_1_2_9_10_1","doi-asserted-by":"publisher","DOI":"10.7448\/IAS.19.1.20903"},{"key":"e_1_2_9_11_1","doi-asserted-by":"publisher","DOI":"10.1080\/21645515.2016.1276138"},{"key":"e_1_2_9_12_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa0908492"},{"key":"e_1_2_9_13_1","unstructured":"National Institute of Allergy and Infectious Diseases.NIH\u2010sponsored HIV vaccine trial launches in South Africa: early\u2010stage trial aims to build on RV144 results.NIH News.2015[cited 2015 Jul 31]. 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