Weill Cornell Medical College, New York, New York, USA.
Curr Opin HIV AIDS. 2012 Nov;7(6):587-92. doi: 10.1097/COH.0b013e3283582c8b.
The US Food and Drug Administration (FDA) recently approved the use of tenofovir-emtricitabine for pre-exposure prophylaxis (PrEP) for HIV prevention. PrEP is also being investigated in clinical trials as a component of HIV prevention in resource-limited settings. Cost-effectiveness models are useful in identifying health programs with the greatest societal value and projecting long-term program impacts. This review examines six recent studies of the cost-effectiveness of PrEP for preventing HIV transmission in the USA and South Africa.
Studies used both individual-level and population-level transmission models. PrEP was found to be a cost-effective HIV-prevention intervention in high-risk MSM with HIV incidence at least 2% in the USA (<US$100 000 per quality-adjusted life year) and in young women in South Africa (cost per life year <GDP per capita). Results were sensitive to the cost and efficacy of PrEP and to assumptions about HIV testing and access to treatment in the absence of PrEP.
Future cost effectiveness studies should consider PrEP implementation issues (uptake in high-risk versus low-risk groups, duration on PrEP, adherence), budget impact, and the role of PrEP as part of combination HIV-prevention strategies including expanded testing and treatment access.
目的综述：美国食品药品监督管理局（FDA）最近批准了替诺福韦恩曲他滨用于暴露前预防（PrEP）以预防艾滋病毒。PrEP 也正在临床试验中作为资源有限环境下预防艾滋病毒的一种组成部分进行研究。成本效益模型有助于确定具有最大社会价值的卫生规划，并预测长期规划影响。这篇综述考察了最近六项关于替诺福韦恩曲他滨用于预防美国和南非艾滋病毒传播的成本效益的研究。
最新发现：研究使用了个体和人群传播模型。替诺福韦恩曲他滨在 HIV 发病率至少为 2%的美国高风险男男性行为者（每质量调整生命年成本低于 10 万美元）和南非年轻女性中，被发现是一种具有成本效益的艾滋病毒预防干预措施（每生命年成本低于人均 GDP）。结果对 PrEP 的成本和疗效以及对 PrEP 缺失时 HIV 检测和治疗机会的假设敏感。
总结：未来的成本效益研究应考虑 PrEP 的实施问题（高风险与低风险人群的使用、PrEP 的持续时间、依从性）、预算影响以及 PrEP 在扩大检测和治疗机会等组合 HIV 预防策略中的作用。
