Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montréal, Québec.
Can J Infect Dis Med Microbiol. 2015 Jan-Feb;26(1):23-9. doi: 10.1155/2015/964512.
Recent trials report the efficacy of continuous tenofovir-based pre-exposure prophylaxis (PrEP) for prevention of HIV infection. The cost effectiveness of 'on demand' PrEP for non-injection drug-using men who have sex with men at high risk of HIV acquisition has not been evaluated.
To conduct an economic evaluation of the societal costs of HIV in Canada and evaluate the potential benefits of this PrEP strategy.
Direct HIV costs comprised outpatient, inpatient and emergency department costs, psychosocial costs and antiretroviral costs. Resource consumption estimates were derived from the Centre Hospitalier de l'Université de Montréal HIV cohort. Estimates of indirect costs included employment rate and work absenteeism. Costs for 'on demand' PrEP were modelled after an ongoing clinical trial. Cost-effectiveness analysis compared costs of 'on demand' PrEP to prevent one infection with lifetime costs of one HIV infection. Benefits were presented in terms of life-years and quality-adjusted life-years.
The average annual direct cost of one HIV infection was $16,109 in the least expensive antiretroviral regimen scenario and $24,056 in the most expensive scenario. The total indirect cost was $11,550 per year. Total costs for the first year of HIV infection ranged from $27,410 to $35,358. Undiscounted lifetime costs ranged from $1,439,984 ($662,295 discounted at 3% and $448,901 at 5%) to $1,482,502 ($690,075 at 3% and $485,806 at 5%). The annual cost of PrEP was $12,001 per participant, and $621,390 per infection prevented. The PrEP strategy was cost-saving in all scenarios for undiscounted and 3% discounting rates. At 5% discounting rates, the strategy is largely cost-effective: according to least and most expensive scenarios, incremental cost-effectiveness ratios ranged from $60,311 to $47,407 per quality-adjusted life-year.
This 'on demand' PrEP strategy ranges from cost-saving to largely cost-effective. The authors believe it represents an important public health strategy for the prevention of HIV transmission.
最近的试验报告了连续使用替诺福韦为基础的暴露前预防（PrEP）在预防 HIV 感染方面的疗效。对于非注射吸毒的男男性行为者（MSM）高危人群，按需 PrEP 的成本效益尚未得到评估。
对加拿大 HIV 的社会成本进行经济评估，并评估这种 PrEP 策略的潜在收益。
直接 HIV 成本包括门诊、住院和急诊成本、心理社会成本和抗逆转录病毒成本。资源消耗估计来自蒙特利尔大学医院 HIV 队列。间接成本的估计包括就业率和工作缺勤率。按需 PrEP 的成本是根据正在进行的临床试验建模的。成本效益分析比较了按需 PrEP 预防一次感染的成本与一次 HIV 感染的终生成本。效益以生命年和质量调整生命年来表示。
在最便宜的抗逆转录病毒方案情景下，每年感染 HIV 的平均直接成本为 16109 加元，在最昂贵的方案情景下为 24056 加元。每年的总间接成本为 11550 加元。第一年 HIV 感染的总费用从 27410 加元到 35358 加元不等。未贴现的终生费用从 1439984 加元（贴现率为 3%时为 662295 加元，贴现率为 5%时为 448901 加元）到 1482502 加元（贴现率为 3%时为 690075 加元，贴现率为 5%时为 485806 加元）不等。每名参与者每年 PrEP 的费用为 12001 加元，每预防一次感染的费用为 621390 加元。在所有情景下，对于未贴现和 3%贴现率，PrEP 策略都是成本节约的。在 5%贴现率下，该策略基本具有成本效益：根据最昂贵和最便宜的方案，增量成本效益比范围从每质量调整生命年 60311 加元到 47407 加元不等。
这种“按需”PrEP 策略从成本节约到基本具有成本效益。作者认为，这代表了预防 HIV 传播的一项重要公共卫生策略。
