荷兰预防 HIV-1 感染的暴露前预防的成本效益分析：一项数学建模研究。

Cost-effectiveness analysis of pre-exposure prophylaxis for HIV-1 prevention in the Netherlands: a mathematical modelling study.

机构信息

Department of Viroscience, Erasmus Medical Center, Rotterdam, Netherlands.

出版信息

Lancet Infect Dis. 2016 Dec;16(12):1423-1429. doi: 10.1016/S1473-3099(16)30311-5. Epub 2016 Sep 22.

DOI:10.1016/S1473-3099(16)30311-5

PMID:27665989

Abstract

BACKGROUND

Pre-exposure prophylaxis (PrEP) with tenofovir and emtricitabine prevents HIV infections among men who have sex with men (MSM). PrEP can be given on a daily or intermittent basis. Unfortunately, PrEP is not reimbursed in most European countries. Cost-effectiveness analyses of PrEP among MSM in Europe are absent but are key for decision makers to decide upon PrEP implementation.

METHODS

We developed a deterministic mathematical model, calibrated to the well defined Dutch HIV epidemic among MSM, to predict the effect and cost-effectiveness of PrEP. PrEP was targeted to 10% of highly sexually active Dutch MSM over the coming 40 years. Cost-effectiveness ratios were calculated to predict the cost-effectiveness of daily and on-demand PrEP. Cost-effectiveness ratios below €20 000 were considered to be cost-effective in this analysis.

FINDINGS

Within the context of a stable HIV epidemic, at 80% effectiveness and current PrEP pricing, PrEP can cost as much as €11 000 (IQR 9400-14 100) per quality-adjusted life-year (QALY) gained when used daily, or as little as €2000 (IQR 1300-3000) per QALY gained when used on demand. At 80% effectiveness, daily PrEP can be considered cost-saving if the price of PrEP is reduced by 70%, and on-demand PrEP can be considered cost-saving if the price is reduced by 30-40%.

INTERPRETATION

PrEP for HIV prevention among MSM in the Netherlands is cost-effective. The use of PrEP is most cost-effective when the price of PrEP is reduced through on-demand use or through availability of generic PrEP, and can quickly be considered cost-saving.

FUNDING

None.

摘要

背景

替诺福韦和恩曲他滨的暴露前预防（PrEP）可预防男男性行为者（MSM）中的 HIV 感染。PrEP 可以每日或间断给药。遗憾的是，在大多数欧洲国家，PrEP 并未得到报销。欧洲 MSM 中 PrEP 的成本效益分析尚不存在，但对于决策者决定实施 PrEP 至关重要。

方法

我们开发了一个确定性的数学模型，该模型针对明确界定的荷兰 MSM 中的 HIV 流行情况进行了校准，以预测 PrEP 的效果和成本效益。在未来 40 年内，PrEP 将针对 10%高度活跃的荷兰 MSM 进行靶向治疗。计算成本效益比以预测每日和按需 PrEP 的成本效益。在本分析中，成本效益比低于 20,000 欧元被认为具有成本效益。

发现

在 HIV 流行稳定的情况下，在 80%的有效性和当前 PrEP 定价下，每日使用 PrEP 的每质量调整生命年（QALY）成本可能高达 11,000 欧元（IQR 9400-14,100），而按需使用时的每 QALY 成本可能低至 2,000 欧元（IQR 1300-3000）。在 80%的有效性下，如果 PrEP 的价格降低 70%，则每日 PrEP 可被视为节省成本，如果价格降低 30-40%，则按需 PrEP 可被视为节省成本。