Research Centre for Public Health, Tsinghua University, Beijing, China.
Melbourne Sexual Health Centre, Alfred Health, Melbourne, Australia.
AIDS Behav. 2019 Feb;23(2):523-533. doi: 10.1007/s10461-018-2205-3.
Risk of HIV infection is high in Chinese MSM, with an annual HIV incidence ranging from 3.41 to 13.7/100 person-years. Tenofovir-based PrEP is effective in preventing HIV transmission in MSM. This study evaluates the epidemiological impact and cost-effectiveness of implementing PrEP in Chinese MSM over the next two decades. A compartmental model for HIV was used to forecast the impact of PrEP on number of infections, deaths, and disability-adjusted life years (DALY) averted. We also provide an estimate of the incremental cost-effectiveness ratio (ICER) and the cost per DALY averted of the intervention. Without PrEP, there will be 1.1-3.0 million new infections and 0.7-2.3 million HIV-related deaths in the next two decades. Moderate PrEP coverage (50%) would prevent 0.17-0.32 million new HIV infections. At Truvada's current price in China, daily oral PrEP costs $46,813-52,008 per DALY averted and is not cost-effective; on-demand Truvada reduces ICER to $25,057-27,838 per DALY averted, marginally cost-effective; daily generic tenofovir-based regimens further reduce ICER to $3675-8963, wholly cost-effective. The cost of daily oral Truvada PrEP regimen would need to be reduced by half to achieve cost-effectiveness and realize the public health good of preventing hundreds of thousands of HIV infections among MSM in China.
中国男男性行为者（MSM）中的 HIV 感染风险较高，年 HIV 发病率在 3.41 至 13.7/100 人年之间。基于替诺福韦的 PrEP 可有效预防 MSM 中的 HIV 传播。本研究评估了在未来二十年中在 MSM 中实施 PrEP 的流行病学影响和成本效益。使用 HIV compartmental 模型来预测 PrEP 对感染人数、死亡人数和避免的残疾调整生命年（DALY）的影响。我们还提供了干预措施的增量成本效益比（ICER）和避免每 DALY 的增量成本的估计值。如果不使用 PrEP，在未来二十年中，将有 110-300 万例新的 HIV 感染和 70-230 万例与 HIV 相关的死亡。适度的 PrEP 覆盖率（50%）将预防 0.17-0.32 万例新的 HIV 感染。在中国，特鲁瓦达目前的价格下，每日口服 PrEP 每避免一个 DALY 的成本为 46813-52008 美元，不具有成本效益；按需特鲁瓦达将 ICER 降低至每避免一个 DALY 25057-27838 美元，略有成本效益；每日通用替诺福韦方案进一步将 ICER 降低至 3675-8963 美元，具有完全成本效益。每日口服特鲁瓦达 PrEP 方案的成本需要降低一半才能实现成本效益，并实现预防中国数十万 MSM 感染 HIV 的公共卫生效益。
