Moameri Hossein, Goudarzi Reza, Haghdoost Ali Akbar, Gouya Mohammad Mehdi, Saberi Parya, Mirzazadeh Ali, Shahrbabaki Parvin Mangolian, Sharifi Hamid
Student Research Committee, School of Public Health, Kerman University of Medical Sciences, Kerman, Iran.
Health Services Management Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran.
Sci Rep. 2025 Mar 5;15(1):7747. doi: 10.1038/s41598-025-92099-1.
The Iranian government does not fund pre-exposure prophylaxis (PrEP), and it is not used in Iran due to uncertainties in its cost-effectiveness. In this study, we examined the cost-effectiveness of PrEP among female sex workers (FSWs) in Iran. The cost-effectiveness analysis compared only PrEP, a combination of PrEP with harm reduction (HR) with only HR scenario among FSWs over a 10-year time horizon. The perspective of the healthcare provider was used in the analysis. The primary outcome was disability-adjusted life year (DALY) averted. Analyses included health and cost outcomes, as well as the incremental cost-effectiveness ratio (ICER), which was reported as the cost per DALY averted. Only PrEP was not cost-effective at a willingness to pay threshold of 4669.6 USD per DALY averted in Iran. In contrast, PrEP and HR strategies were cost-effective at the same willingness to pay threshold. The ICER was 868.47 USD per DALY averted for PrEP and HR compared to HR alone. Compared to HR, combining PrEP with HR is a cost-effective intervention among Iranian FSWs for reducing the clinical and economic burden associated with HIV over a 10-year time horizon. Iran should add PrEP to current HR programs for FSWs.
伊朗政府不资助暴露前预防（PrEP），并且由于其成本效益存在不确定性，PrEP在伊朗未被使用。在本研究中，我们考察了PrEP在伊朗女性性工作者（FSW）中的成本效益。成本效益分析仅比较了PrEP、PrEP与减少伤害（HR）相结合以及仅采用HR方案这三种情况，时间跨度为10年，针对女性性工作者群体。分析采用了医疗服务提供者的视角。主要结局指标是避免的伤残调整生命年（DALY）。分析包括健康和成本结局，以及增量成本效益比（ICER），以每避免一个DALY的成本来报告。在伊朗，以每避免一个DALY支付意愿阈值为4669.6美元时，仅PrEP不具有成本效益。相比之下，PrEP与HR策略在相同支付意愿阈值下具有成本效益。与仅采用HR相比，PrEP与HR相结合时的ICER为每避免一个DALY 868.47美元。在10年时间跨度内，与HR相比，PrEP与HR相结合对于减轻伊朗女性性工作者中与艾滋病毒相关的临床和经济负担而言，是一种具有成本效益的干预措施。伊朗应将PrEP纳入当前针对女性性工作者的减少伤害项目中。
