Ong Koh Jun, Desai Sarika, Field Nigel, Desai Monica, Nardone Anthony, van Hoek Albert Jan, Gill Owen Noel
HIV & STI Department, National Centre for Infectious Disease Surveillance and Control (CIDSC), Public Health England, London, United Kingdom.
Research Department of Infection & Population Health, University College London, London, United Kingdom.
Euro Surveill. 2017 Oct;22(42). doi: 10.2807/1560-7917.ES.2017.22.42.17-00192.
Clinical effectiveness of pre-exposure prophylaxis (PrEP) for preventing HIV acquisition in men who have sex with men (MSM) at high HIV risk is established. A static decision analytical model was constructed to inform policy prioritisation in England around cost-effectiveness and budgetary impact of a PrEP programme covering 5,000 MSM during an initial high-risk period. National genitourinary medicine clinic surveillance data informed key HIV risk assumptions. Pragmatic large-scale implementation scenarios were explored. At 86% effectiveness, PrEP given to 5,000 MSM at 3.3 per 100 person-years annual HIV incidence, assuming risk compensation (20% HIV incidence increase), averted 118 HIV infections over remaining lifetimes and was cost saving. Lower effectiveness (64%) gave an incremental cost-effectiveness ratio of + GBP 23,500 (EUR 32,000) per quality-adjusted life year (QALY) gained. Investment of GBP 26.9 million (EUR 36.6 million) in year-1 breaks even anywhere from year-23 (86% effectiveness) to year-33 (64% effectiveness). PrEP cost-effectiveness was highly sensitive to year-1 HIV incidence, PrEP adherence/effectiveness, and antiretroviral drug costs. There is much uncertainty around HIV incidence in those given PrEP and adherence/effectiveness, especially under programme scale-up. Substantially reduced PrEP drug costs are needed to give the necessary assurance of cost-effectiveness, and for an affordable public health programme of sufficient size.
暴露前预防（PrEP）对预防高危男男性行为者（MSM）感染艾滋病毒具有临床有效性。构建了一个静态决策分析模型，以指导英国围绕一项在初始高危期覆盖5000名男男性行为者的PrEP计划的成本效益和预算影响进行政策优先排序。国家性传播感染诊所监测数据为关键的艾滋病毒风险假设提供了依据。探索了务实的大规模实施情景。在有效性为86%的情况下，对5000名男男性行为者给予PrEP，假设每年艾滋病毒发病率为每100人年3.3例，存在风险补偿（艾滋病毒发病率增加20%），在剩余寿命期间可避免118例艾滋病毒感染，且具有成本节约效益。较低的有效性（64%）导致每获得一个质量调整生命年（QALY）的增量成本效益比为+23500英镑（32000欧元）。在第1年投资2690万英镑（3660万欧元），在第23年（有效性86%）至第33年（有效性64%）之间实现收支平衡。PrEP的成本效益对第1年的艾滋病毒发病率、PrEP依从性/有效性和抗逆转录病毒药物成本高度敏感。在接受PrEP者的艾滋病毒发病率以及依从性/有效性方面存在很大不确定性，尤其是在项目扩大规模的情况下。需要大幅降低PrEP药物成本，以确保成本效益，并实现一个规模足够大且负担得起的公共卫生项目。
