A Cost-effectiveness Analysis of Preexposure Prophylaxis for the Prevention of HIV Among Los Angeles County Men Who Have Sex With Men

Drabo, Emmanuel Fulgence; Hay, Joel W.; Vardavas, Raffaele; Wagner, Zachary; Sood, Neeraj

doi:10.1093/cid/ciw578

Cited by 54 publications

(49 citation statements)

References 26 publications

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“…We searched PubMed from 1 January 2013 to 11 October 2017 with the terms "HIV" AND ("PrEP" OR "PrEP") AND ("cost" OR "costeffectiveness") with the goal of identifying any new studies that have appeared since the 2013 meta-analysis of PrEP cost-effectiveness modelling studies [32]. The search retrieved 149 abstracts, of which 21 provided country-specific estimates of the cost-effectiveness of various PrEP implementation strategies [6,8,9,[33][34][35][36][37][38][39][40][41][42][43][44][45][46][47][48][49]. This study is not only the first to provide data and evidence on the costs and cost-effectiveness of providing oral PrEP to MSM in Thailand, but is also the first such study from the Asia-Pacific region.…”

Section: Discussionmentioning

confidence: 99%

Cost and cost‐effectiveness analysis of pre‐exposure prophylaxis among men who have sex with men in two hospitals in Thailand

et al. 2018

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IntroductionIn 2014, the Government of Thailand recommended pre‐exposure prophylaxis (PrEP) as an additional HIV prevention programme within Thailand's National Guidelines on HIV/AIDS Treatment Prevention. However, to date implementation and uptake of PrEP programmes have been limited, and evidence on the costs and the epidemiological and economic impact is not available.MethodsWe estimated the costs associated with PrEP provision among men having sex with men (MSM) participating in a facility‐based, prospective observational cohort study: the Test, Treat and Prevent HIV Programme in Thailand. We created a suite of scenarios to estimate the cost‐effectiveness of PrEP and sensitivity of the results to the model input parameters, including PrEP programme effectiveness, PrEP uptake among high‐risk and low‐risk MSM, baseline and future antiretroviral therapy (ART) coverage, condom use, unit cost of delivering PrEP, and the discount rate.ResultsDrug costs accounted for 82.5% of the total cost of providing PrEP, followed by lab testing (8.2%) and personnel costs (7.8%). The estimated costs of providing the PrEP package in accordance with the national recommendation ranges from US$223 to US$311 per person per year. Based on our modelling results, we estimate that PrEP would be cost‐effective when provided to either high‐risk or all MSM. However, we found that the programme would be approximately 32% more cost‐effective if offered to high‐risk MSM than it would be if offered to all MSM, with an incremental cost‐effectiveness ratio of US$4,836 per disability‐adjusted life years (DALY) averted and US$7,089 per DALY averted respectively. Cost‐effectiveness acceptability curves demonstrate that 80% of scenarios would be cost‐effective when PrEP is provided solely to higher‐risk MSM.ConclusionWe provide the first estimates on cost and cost‐effectiveness of PrEP in the Asia‐Pacific region, and offer insights on how to deliver PrEP in combination with ART. While the high drug cost poses a budgeting challenge, incorporating PrEP delivery into an existing ART programme could be a cost‐effective strategy to prevent HIV infections among MSM in Thailand.

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Section: Discussionmentioning

confidence: 99%

Cost and cost‐effectiveness analysis of pre‐exposure prophylaxis among men who have sex with men in two hospitals in Thailand

et al. 2018

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“…Studies have consistently shown that PrEP is cost-effective in populations with highly concentrated HIV epidemics. A study comparing various strategies to curb HIV transmission among MSM living in San Francisco found PrEP to be cost effective at a cost of $27,863–$37,181 quality-adjusted life years (QALY) gained (U.S. threshold $150,000) (Drabo, Hay, Vardavas, Wagner, & Sood, 2016). These findings are consistent with a study in New York City, which found that PrEP among high risk MSM would cost $32,000/QALY (Desai et al, 2008).…”

Section: Addressing Barriers To Prep Uptakementioning

confidence: 99%

Promoting Pre-exposure Prophylaxis to Prevent HIV Infections Among Sexual and Gender Minority Hispanics/Latinxs

Page

Martínez

Nieves-Lugo

et al. 2017

AIDS Education and Prevention

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Sexual and gender minority Hispanics/Latinxs (henceforth: Latinxs) continue to be disproportionately impacted by HIV/AIDS in the U.S. Pre-exposure prophylaxis (PrEP) is a biomedical prevention approach which holds significant promise for at risk and vulnerable populations. We discuss barriers and facilitators to uptake of PrEP among sexual and gender minority Latinxs living in the U.S. through an ecosocial lens that takes into account structural, community, and individual contexts. The impact of immigration status on PrEP uptake emerges as a major and recurrent theme that must be understood and addressed by HIV prevention programs aiming to promote an inclusive strategy for sexual and gender minority Latinxs living in the U.S.

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“…Substantial gaps remain in understanding the trade-offs between the costs and benefits of choosing alternative HIV prevention strategies, such as the initiation of PrEP by high risk uninfected individuals [13]. Mathematical models of HIV that include PrEP are scarce [6].…”

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confidence: 99%

Modeling and optimal control of HIV/AIDS prevention through PrEP

Silva¹,

Torres²

2018

Discrete &Amp; Continuous Dynamical Systems - S

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Pre-exposure prophylaxis (PrEP) consists in the use of an antiretroviral medication to prevent the acquisition of HIV infection by uninfected individuals and has recently demonstrated to be highly efficacious for HIV prevention. We propose a new epidemiological model for HIV/AIDS transmission including PrEP. Existence, uniqueness and global stability of the disease free and endemic equilibriums are proved. The model with no PrEP is calibrated with the cumulative cases of infection by HIV and AIDS reported in Cape Verde from 1987 to 2014, showing that it predicts well such reality. An optimal control problem with a mixed state control constraint is then proposed and analyzed, where the control function represents the PrEP strategy and the mixed constraint models the fact that, due to PrEP costs, epidemic context and program coverage, the number of individuals under PrEP is limited at each instant of time. The objective is to determine the PrEP strategy that satisfies the mixed state control constraint and minimizes the number of individuals with pre-AIDS HIV-infection as well as the costs associated with PrEP. The optimal control problem is studied analytically. Through numerical simulations, we demonstrate that PrEP reduces HIV transmission significantly.Comment: This is a preprint of a paper whose final and definite form is with 'Discrete and Continuous Dynamical Systems -- Series S' (DCDS-S), ISSN 1937-1632 (print), ISSN 1937-1179 (online), available at [https://www.aimsciences.org/journals/home.jsp?journalID=15]. In this version, typos detected while reading the proofs were correcte

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A Cost-effectiveness Analysis of Preexposure Prophylaxis for the Prevention of HIV Among Los Angeles County Men Who Have Sex With Men

Abstract: PrEP and test-and-treat offer cost-effective alternatives to the status quo. The success of these strategies depends on ART and PrEP adherence and initiation rates. The lack of evidence on adherence behaviors toward PrEP, therefore, warrants further studies.

Cited by 54 publications

References 26 publications

Cost and cost‐effectiveness analysis of pre‐exposure prophylaxis among men who have sex with men in two hospitals in Thailand

Cost and cost‐effectiveness analysis of pre‐exposure prophylaxis among men who have sex with men in two hospitals in Thailand

Promoting Pre-exposure Prophylaxis to Prevent HIV Infections Among Sexual and Gender Minority Hispanics/Latinxs

Modeling and optimal control of HIV/AIDS prevention through PrEP

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