Department of Management Science and Engineering, Stanford University, Stanford.
VA Palo Alto Health Care System, Palo Alto.
AIDS. 2018 Mar 13;32(5):663-672. doi: 10.1097/QAD.0000000000001747.
Oral HIV preexposure prophylaxis (PrEP) has been recommended as a means of HIV prevention among people who inject drugs (PWIDs) but, at current prices, is unlikely to be cost-effective for all PWID.
To determine the cost-effectiveness of alternative strategies for enrolling PWID in PrEP.
Dynamic network model that captures HIV transmission and progression among PWID in a representative US urban center.
HIV infections averted, discounted costs and quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratios.
We assume 25% PrEP coverage and investigate four strategies: first, random PWID are enrolled (Unselected Enrollment); second, individuals are randomly selected and enrolled together with their partners (Enroll Partners); third, individuals with the highest number of sexual and needle-sharing partnerships are enrolled (Most Partners); fourth, individuals with the greatest number of infected partners are enrolled (Most Positive Partners).
PrEP can achieve significant health benefits: compared with the status quo of no PrEP, the strategies gain 1114 QALYs (Unselected Enrollment), 2194 QALYs (Enroll Partners), 2481 QALYs (Most Partners), and 3046 QALYs (Most Positive Partners) over 20 years in a population of approximately 8500 people. The incremental cost-effectiveness ratio of each strategy compared with the status quo (cost per QALY gained) is $272 000 (Unselected Enrollment), $158 000 (Enroll Partners), $124 000 (Most Partners), and $101 000 (Most Positive Partners). All strategies except Unselected Enrollment are cost-effective according to WHO criteria.
Selection of high-risk PWID for PrEP can improve the cost-effectiveness of PrEP for PWID.
口腔艾滋病毒暴露前预防（PrEP）已被推荐为注射吸毒者（PWID）预防艾滋病毒的一种手段，但以目前的价格，对所有 PWID 来说不太可能具有成本效益。
确定招募 PWID 接受 PrEP 的替代策略的成本效益。
动态网络模型，可在具有代表性的美国城市中心捕获 PWID 中的艾滋病毒传播和进展。
避免的艾滋病毒感染，贴现成本和质量调整生命年（QALYs）以及增量成本效益比。
我们假设 PrEP 覆盖率为 25%，并调查了四种策略：首先，随机招募 PWID（非选择性招募）；其次，随机选择个人并与其伴侣一起招募（招募伴侣）；第三，招募具有最多性伴和共用针头伙伴的个人（最多伙伴）；第四，招募具有最多感染伙伴的个人（最多阳性伙伴）。
PrEP 可以带来显著的健康益处：与没有 PrEP 的现状相比，这些策略在大约 8500 人的人群中在 20 年内获得了 1114 个 QALYs（非选择性招募），2194 个 QALYs（招募伴侣），2481 个 QALYs（最多伙伴）和 3046 个 QALYs（最多阳性伙伴）。与现状相比，每种策略的增量成本效益比（每获得一个 QALY 的成本）为 272000 美元（非选择性招募），158000 美元（招募伴侣），124000 美元（最多伙伴）和 101000 美元（最多阳性伙伴）。根据世界卫生组织的标准，除非选择性招募外，所有策略均具有成本效益。
为 PrEP 选择高危 PWID 可以提高 PWID 接受 PrEP 的成本效益。
