Department of Internal Medicine and AIDS Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea.
Department of Computational Science and Engineering, Yonsei University, Seoul, Republic of Korea.
Sci Rep. 2020 Sep 3;10(1):14609. doi: 10.1038/s41598-020-71565-y.
In February 2018, the Ministry of Food and Drug Safety in Korea approved tenofovir disoproxil fumarate and emtricitabine (TDF/FTC) co-formulate for use in pre-exposure prophylaxis (PrEP) for the prevention of human immunodeficiency virus (HIV) infection. This study aimed to estimate the cost-effectiveness of PrEP in men who have sex with men (MSM), a major risk group emerging in Korea. A dynamic compartmental model was developed for HIV transmission and progression in MSM aged 15-64 years. With a combined model including economic analysis, we estimated averted HIV infections, changes in HIV prevalence, discounted costs, quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratios (ICERs). PrEP was evaluated in both the general MSM and high-risk MSM populations and was assumed to reduce infection risk by 80%. Implementing PrEP in all MSM would avert 75.2% HIV infections and facilitate a gain of 37,372 QALYs at a cost of $274,822 per QALY gained over 20 years relative to the status quo. Initiating PrEP in high-risk MSM with an average of eight partners per year (around 20% of MSM) would improve the cost-effectiveness, averting 78.0% HIV infections and add 29,242 QALYs at a cost of $51,597 per QALY gained, which is within the willingness-to-pay threshold for Korea of $56,000/QALY gained. This result was highly sensitive to annual PrEP costs, quality-of-life for people who are on PrEP, and initial HIV prevalence. Initiating PrEP in a larger proportion of MSM in Korea would prevent more HIV infections, but at an increasing cost per QALY gained. Focusing PrEP on higher risk MSM and any reduction in PrEP cost would improve cost-effectiveness.
2018 年 2 月，韩国食品药品安全部批准将替诺福韦二吡呋酯富马酸和恩曲他滨（TDF/FTC）复方制剂用于预防人类免疫缺陷病毒（HIV）感染的暴露前预防（PrEP）。本研究旨在评估在韩国新出现的主要感染风险群体男男性行为者（MSM）中开展 PrEP 的成本效益。研究建立了一个用于 15-64 岁 MSM 中 HIV 传播和进展的动态房室模型。通过包含经济分析的联合模型，我们估计了预防的 HIV 感染、HIV 流行率变化、贴现成本、质量调整生命年（QALY）和增量成本效益比（ICER）。PrEP 在一般 MSM 和高风险 MSM 人群中进行了评估，并假设其能降低 80%的感染风险。在所有 MSM 中实施 PrEP 将预防 75.2%的 HIV 感染，并在 20 年内以每 QALY 增加 274822 美元的成本，使 37372 个 QALY 得到改善。在高风险 MSM 中启动 PrEP，每年平均有 8 个性伴侣（约占 MSM 的 20%），可提高成本效益，预防 78.0%的 HIV 感染，并增加 29242 个 QALY，每 QALY 增加成本为 51597 美元，这符合韩国每 QALY 增加 56000 美元的意愿支付阈值。该结果对 PrEP 年成本、接受 PrEP 者的生活质量和初始 HIV 流行率高度敏感。在韩国更大比例的 MSM 中启动 PrEP 将预防更多的 HIV 感染，但每 QALY 增加的成本也会增加。将 PrEP 重点放在高风险 MSM 上，并降低 PrEP 成本，将提高成本效益。
