Cost-effectiveness of pre-exposure prophylaxis for HIV prevention in men who have sex with men in the UK: a modelling study and health economic evaluation
| Autor: | Alison Rodger, Nigel Field, Andrew N. Phillips, Monica Desai, Koh Jun Ong, O Noel Gill, Alec Miners, Valerie Delpech, Gus Cairns, Valentina Cambiano, Graham Hart, Sheena McCormack, Anthony Nardone, David Dunn |
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| Rok vydání: | 2018 |
| Předmět: |
Adult
Male 0301 basic medicine Gerontology medicine.medical_specialty Adolescent Anti-HIV Agents Cost effectiveness Cost-Benefit Analysis 030106 microbiology HIV Infections Emtricitabine Article Men who have sex with men Sexual and Gender Minorities Young Adult 03 medical and health sciences Pre-exposure prophylaxis 0302 clinical medicine Disease Transmission Infectious medicine Humans 030212 general & internal medicine Homosexuality Male Tenofovir health care economics and organizations Cost–benefit analysis business.industry Public health HIV virus diseases Middle Aged United Kingdom Sexual intercourse Infectious Diseases England Economic evaluation Pre-Exposure Prophylaxis business Demography medicine.drug |
| Zdroj: | The Lancet Infectious Diseases. 18:85-94 |
| ISSN: | 1473-3099 |
| DOI: | 10.1016/s1473-3099(17)30540-6 |
| Popis: | Summary Background In the UK, HIV incidence among men who have sex with men (MSM) has remained high for several years, despite widespread use of antiretroviral therapy and high rates of virological suppression. Pre-exposure prophylaxis (PrEP) has been shown to be highly effective in preventing further infections in MSM, but its cost-effectiveness is uncertain. Methods In this modelling study and economic evaluation, we calibrated a dynamic, individual-based stochastic model, the HIV Synthesis Model, to multiple data sources (surveillance data provided by Public Health England and data from a large, nationally representative survey, Natsal-3) on HIV among MSM in the UK. We did a probabilistic sensitivity analysis (sampling 22 key parameters) along with a range of univariate sensitivity analyses to evaluate the introduction of a PrEP programme with sexual event-based use of emtricitabine and tenofovir for MSM who had condomless anal sexual intercourse in the previous 3 months, a negative HIV test at baseline, and a negative HIV test in the preceding year. The main model outcomes were the number of HIV infections, quality-adjusted life-years (QALYs), and costs. Findings Introduction of such a PrEP programme, with around 4000 MSM initiated on PrEP by the end of the first year and almost 40 000 by the end of the 15th year, would result in a total cost saving (£1·0 billion discounted), avert 25% of HIV infections (42% of which would be directly because of PrEP), and lead to a gain of 40 000 discounted QALYs over an 80-year time horizon. This result was particularly sensitive to the time horizon chosen, the cost of antiretroviral drugs (for treatment and PrEP), and the underlying trend in condomless sex. Interpretation This analysis suggests that the introduction of a PrEP programme for MSM in the UK is cost-effective and possibly cost-saving in the long term. A reduction in the cost of antiretroviral drugs (including the drugs used for PrEP) would substantially shorten the time for cost savings to be realised. Funding National Institute for Health Research. |
| Databáze: | OpenAIRE |
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