School of Public Health and Community Medicine, University of New South Wales, Sydney, Australia.
HIV Med. 2009 Apr;10(4):199-208. doi: 10.1111/j.1468-1293.2008.00670.x. Epub 2009 Jan 22.
The aim of the study was to determine the cost-effectiveness of HIV nonoccupational post-exposure prophylaxis (NPEP) in Australia.
A retrospective cost analysis of a population-based observational cohort of 1601 participants eligible for NPEP in Australia between 1998 and 2004 was carried out. We modelled NPEP treatment costs and combined them with effectiveness outcomes to calculate the cost per seroconversion avoided. We estimated the cost-utility of the programme, and sensitivity and threshold analysis was performed on key variables.
The average NPEP cost per patient was A$1616, of which A$848 (52%) was for drugs, A$331 (21%) for consultations, A$225 (14%) for pathology and A$212 (13%) for other costs. The cost per seroconversion avoided in the cohort was A$1 647,476 in our base case analysis, and A$512,410 when transmission rates were set at their maximal values. The cost per quality-adjusted life-year (QALY) was between A$40,673 and A$176,772, depending on the risks of HIV transmission assumed.
In our base case, NPEP was not a cost-effective intervention compared with the widely accepted Australian threshold of A$50,000 per QALY. It was only cost-effective after receptive unprotected anal intercourse exposure to an HIV-positive source. Although NPEP was a relatively well-targeted intervention in Australia, its cost-effectiveness could be improved by further targeting high-risk exposures.
本研究旨在确定澳大利亚艾滋病毒非职业性接触后预防（NPEP）的成本效益。
对 1998 年至 2004 年间澳大利亚符合 NPEP 条件的 1601 名参与者进行了基于人群的观察性队列的回溯性成本分析。我们对 NPEP 治疗成本进行建模，并将其与效果结果相结合，以计算每例避免血清转化的成本。我们估算了该项目的成本效益，并对关键变量进行了敏感性和阈值分析。
每位患者的 NPEP 平均成本为 1616 澳元，其中 848 澳元（52%）用于药物，331 澳元（21%）用于咨询，225 澳元（14%）用于病理学检查，212 澳元（13%）用于其他费用。在我们的基础案例分析中，队列中每例避免血清转化的成本为 1647476 澳元，当传播率设定为最大值时，成本为 512410 澳元。每质量调整生命年（QALY）的成本在 40673 澳元至 176772 澳元之间，具体取决于所假设的 HIV 传播风险。
在我们的基础案例中，与澳大利亚普遍接受的每 QALY50000 澳元的阈值相比，NPEP 不是一种具有成本效益的干预措施。只有在接受无保护的肛交暴露于 HIV 阳性源后，NPEP 才具有成本效益。尽管 NPEP 在澳大利亚是一种相对有针对性的干预措施，但通过进一步针对高风险暴露，其成本效益可以得到提高。
