Cambiano Valentina, Miners Alec, Phillips Andrew
aResearch Department of Infection and Population Health, UCL bDepartment of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK.
Curr Opin HIV AIDS. 2016 Jan;11(1):56-66. doi: 10.1097/COH.0000000000000217.
The WHO recommends preexposure prophylaxis (PrEP) in populations at substantial risk of HIV. Despite a number of randomized controlled trials demonstrating its efficacy, and several ongoing implementation projects, PrEP is currently only available in a few countries. Modelling studies can provide useful insights into the long-term impact of introducing PrEP in different subgroups of the population. The review summarizes studies that either evaluated the cost-effectiveness or the cost of introducing PrEP, focusing on seven published in the last year.
These studies used a number of different types of models and investigated the introduction of PrEP in different settings. Among men having sex with men (MSM) in North America, PrEP ranged from being cost-saving (while benefiting population health) to costing US $160,000/quality-adjusted life-year gained. Among heterosexual sero-different couples, it varied from around US $5000 to US $10,000/disability-adjusted life-year averted, when PrEP was used until 6 or 12 months after the HIV-positive partner had initiated antiretroviral therapy (ART) in, respectively, Uganda and South Africa.
Future cost-effectiveness studies of PrEP should consider the HIV incidence, the level of uptake, the effect of its introduction on alternative prevention approaches, and the budget impact of rolling it out.
世界卫生组织建议对有高感染艾滋病毒风险的人群进行暴露前预防（PrEP）。尽管多项随机对照试验证明了其有效性，且有几个正在进行的实施项目，但目前PrEP仅在少数国家可用。模型研究可以为在不同人群亚组中引入PrEP的长期影响提供有用的见解。本综述总结了评估PrEP引入的成本效益或成本的研究，重点关注去年发表的七项研究。
这些研究使用了多种不同类型的模型，并研究了在不同环境中引入PrEP的情况。在北美的男男性行为者（MSM）中，PrEP从节省成本（同时有益于人群健康）到每获得一个质量调整生命年花费16万美元不等。在异性血清学不同的夫妇中，当分别在乌干达和南非，PrEP在艾滋病毒阳性伴侣开始抗逆转录病毒治疗（ART）后使用6个月或12个月时，避免每一个伤残调整生命年的成本从约5000美元到10000美元不等。
未来PrEP的成本效益研究应考虑艾滋病毒发病率、接受程度、引入PrEP对替代预防方法的影响以及推广PrEP的预算影响。
