中国男男性行为人群中存在耐药情况下口服暴露前预防和扩大抗逆转录病毒治疗预防HIV感染的成本效益：一项数学建模研究
Cost-effectiveness of oral pre-exposure prophylaxis and expanded antiretroviral therapy for preventing HIV infections in the presence of drug resistance among men who have sex with men in China: A mathematical modelling study.
作者信息
Jin Xinye, Shi Lingen, Wang Congyue, Qiu Tao, Yin Yi, Shen Mingwang, Fu Gengfeng, Peng Zhihang
机构信息
Department of Epidemiology and Biostatistics, School of Public Health, Nanjing Medical University, Nanjing, Jiangsu 211100, China.
Jiangsu Provincial Center for Disease Control and Prevention, Institute for STI and HIV Control and Prevention, Nanjing, Jiangsu 210009, China.
出版信息
Lancet Reg Health West Pac. 2022 May 3;23:100462. doi: 10.1016/j.lanwpc.2022.100462. eCollection 2022 Jun.
BACKGROUND
Oral pre-exposure prophylaxis (PrEP) and antiretroviral therapy (ART) can effectively prevent HIV infections among men who have sex with men (MSM), but the emergence and transmission of HIV drug-resistance (HIVDR) may compromise their benefits. The costs and benefits of expanding PrEP and ART coverage in the presence of HIVDR in China remain unknown.
METHODS
We developed a comprehensive dynamic transmission model incorporating the transmitted (TDR) and acquired (ADR) HIV drug resistance. The model was calibrated by the HIV surveillance data from 2009 to 2019 among MSM in Jiangsu Province, China, and validated by the dynamic prevalence of ADR and TDR. We aimed to investigate the impact of eight intervention scenarios (no PrEP, 20%, 50% or 80% of PrEP, without (77% coverage) or with (90% coverage) expanded ART) on the HIV epidemic trend and cost-effectiveness of PrEP over the next 30 years.
FINDINGS
20% or 50% PrEP + 90% ART would be cost-effective, with an incremental cost-effectiveness ratio (ICER) of 25,417 (95% confidence interval [CI]: 12,390-38,445) or 47,243 (23,756-70,729), and would yield 154,949 (89,662-220,237) or 179,456 (102,570-256,342) incremental quality-adjusted life-years (QALYs) over the next 30 years. No PrEP + 90% ART would yield 125,211 (73,448-176,974) incremental QALYs and be cost-saving. However, 20-80% PrEP + 77% ART and 80% PrEP + 90% ART with ICER of $77,862-$98,338 and $63,332, respectively, and were not cost-effective. A reduction of 64% in the annual cost of oral PrEP would make it highly cost-effective for 50% PrEP + 90% ART.
INTERPRETATION
20% or 50% PrEP + 90% ART is cost-effective for HIV control in the presence of HIVDR. Expanded ART alone may be the optimal policy under the current limited budgets.
FUNDING
National Natural Science Foundation of China, the National S&T Major Project Foundation of China.
背景
口服暴露前预防（PrEP）和抗逆转录病毒疗法（ART）可有效预防男男性行为者（MSM）感染艾滋病毒，但艾滋病毒耐药性（HIVDR）的出现和传播可能会削弱其益处。在中国，在存在HIVDR的情况下扩大PrEP和ART覆盖范围的成本效益仍不明确。
方法
我们开发了一个综合动态传播模型，纳入了传播性（TDR）和获得性（ADR）艾滋病毒耐药性。该模型通过2009年至2019年中国江苏省MSM的艾滋病毒监测数据进行校准，并通过ADR和TDR的动态流行率进行验证。我们旨在研究八种干预情景（无PrEP、20%、50%或80%的PrEP，不扩大ART（覆盖率77%）或扩大ART（覆盖率90%））对未来30年艾滋病毒流行趋势和PrEP成本效益的影响。
研究结果
20%或50%的PrEP + 90%的ART具有成本效益，增量成本效益比（ICER）为25417（95%置信区间[CI]：12390 - 38445）或47243（23756 - 70729），并将在未来30年产生154949（89662 - 220237）或179456（102570 - 256342）的增量质量调整生命年（QALYs）。无PrEP + 90%的ART将产生125211（73448 - 176974）的增量QALYs且节省成本。然而，20% - 80%的PrEP + 77%的ART以及80%的PrEP + 90%的ART，ICER分别为77862 - 98338美元和63332美元，不具有成本效益。口服PrEP的年度成本降低64%将使50%的PrEP + 90%的ART具有高度成本效益。
解读
在存在HIVDR的情况下，20%或50%的PrEP + 90%的ART对艾滋病毒控制具有成本效益。在当前预算有限的情况下，仅扩大ART可能是最优政策。
资助
中国国家自然科学基金、中国国家科技重大专项基金。
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