Stanley Ho Centre for Emerging Infectious Diseases, The Chinese University of Hong Kong, Hong Kong, China.
Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China.
Sci Rep. 2018 Aug 3;8(1):11641. doi: 10.1038/s41598-018-30101-9.
Pre-exposure prophylaxis (PrEP) targeting high-risk men who have sex with men (MSM) has been shown to be a cost-effective HIV control measure. However, the approach could be a challenge in low HIV incidence places with a low proportion of high-risk MSM. To examine the impact of PrEP in such setting in Asia, we developed an epidemic model and conducted cost-effectiveness analysis using empirical multicentre clinical and HIV sequence data from HIV-infected MSM in Hong Kong, in conjunction with behavioural data of local MSM. Without PrEP, the HIV incidence (per 100 person-years) would increase from 1.1 to 1.6 between 2011 and 2021. PrEP could avert 3-63% of total new infections in a five-year period (2017-2021), the variability of which depends on the implementation strategies and combination with test-and-treat. However, under current market drug price in 2016, the incremental cost per quality-adjusted life-year gained (QALYG) of PrEP (USD1583136/QALYG) is almost 3 times higher than test-and-treat intervention alone (USD396874/QALYG). Assuming 93% fall of PrEP drug price and in combination with test-and-treat, putting 30% of MSM on non-targeting PrEP would be more feasible, cost-effective (USD268915/QALYG), and could avert more new infections (40%). PrEP could contribute to HIV epidemic control in a low incidence place.
暴露前预防（PrEP）针对与男性发生性行为的高风险男性（MSM），已被证明是一种具有成本效益的艾滋病毒控制措施。然而，在艾滋病毒发病率低且高风险 MSM 比例低的地方，这种方法可能是一个挑战。为了研究 PrEP 在亚洲这种环境中的影响，我们开发了一种流行病情报模型，并结合香港 HIV 感染 MSM 的多中心临床和 HIV 序列数据以及当地 MSM 的行为数据，进行了成本效益分析。如果不使用 PrEP，2011 年至 2021 年期间，艾滋病毒发病率（每 100 人年）将从 1.1 增加到 1.6。在五年期间（2017-2021 年），PrEP 可避免 3-63%的新发感染，这取决于实施策略和与检测和治疗的结合。然而，在 2016 年的当前市场药物价格下，PrEP 的每获得一个质量调整生命年的增量成本（QALYG）（1583136 美元/QALYG）几乎是单独进行检测和治疗干预（396874 美元/QALYG）的 3 倍。假设 PrEP 药物价格下降 93%，并与检测和治疗相结合，将 30%的 MSM 纳入非目标 PrEP 方案将更可行、更具成本效益（268915 美元/QALYG），并可避免更多的新感染（40%）。PrEP 可有助于控制低发病率地区的艾滋病毒流行。
