Cost-effectiveness of pre-exposure prophylaxis for HIV prevention in men who have sex with men in the UK: a modelling study and health economic evaluation

Abstract

National Institute for Health Research.

The impact, cost and cost‐effectiveness of oral pre‐exposure prophylaxis in sub‐Saharan Africa: a scoping review of modelling contributions and way forward

“…In a recent example from a high‐income setting, an analysis of the cost‐effectiveness of PrEP for MSM in the UK illustrates the sensitivity of the results with the use of different time horizons. With a 20‐year analysis, PrEP for MSM was not a cost‐effective strategy in this setting, but was cost‐effective with a 40‐year analysis, and was cost saving with an 80‐year analysis . Despite these gaps, countries in sub‐Saharan Africa have moved forward with adopting national PrEP policies and implementation is currently underway.…”

Next-Wave HIV Pre-Exposure Prophylaxis Implementation for Gay and Bisexual Men

“…23 Other studies have found that the greater the coverage of the PrEP program (i.e., higher percentages of GBMSM adopting PrEP), the larger both the benefit (i.e., infections averted) and the cost savings, and when PrEP is concentrated only on highest risk individuals, cost saving is slightly higher, but number of infections averted is slightly lower. 24 It is also important to note that most modeling studies do not include potential complications of targeting strategies in their models, for example, the increased cost associated with identifying eligible individuals, or the extent to which targeting may have the paradoxical effect of decreasing uptake among eligible individuals by increasing stigma. 23 There is evidence for both of these dynamics in the current PrEP implementation efforts, 3 which need to be considered in our evaluation of optimal methods for eligibility assessment.…”

“…53 In another modeling analysis, PrEP remains a cost-effective strategy even if STI rates double. 24 At first glance, we might be tempted to recommend educating providers about the data on risk compensation, with the assumption that they would be more likely to prescribe PrEP if they were convinced that its benefits as a prevention strategy outweigh these particular risks. But research indicates that this strategy does not merit such attention, as the concept of risk compensation is a red herring.…”

HIV health care providers are ready to introduce pre‐exposure prophylaxis in Central and Eastern Europe and neighbouring countries: data from the Euroguidelines in Central and Eastern Europe (ECEE) Network Group

“…The risk behaviours chosen by the respondents were: engaging in unprotected sexual contacts with casual partners (81.4%), having multiple sexual partners per year (62.7%), having sex under the influence of drugs or (13) Stigmatization (the perspective that society has on such intervention) 13.51 (10) Lack of acceptance from people at risk 9.46 (7) alcohol (62.7%), being diagnosed with a sexually transmitted infection (STI) in the last year (52%) and engaging in injecting drug use with needle sharing (42.7%). Additional 'other' answers included: 'having sex with HIVpositive partner'; 'bareback sex'; 'being used to postexposure prophylaxis'.…”

“…Although the ECDC meeting report indicated that the cost of drugs was a key obstacle to free provision of PrEP by public health services, this obstacle is probably temporary, given that we will soon be entering a generic drugs era [7]. Moreover, in a recent analysis from the UK, PrEP was found to be not only cost-effective, but also cost-saving in the long term [13]. The cost of drugs was the third most important obstacle selected by our respondents, suggesting the need to undertake cost-effectiveness analyses specific for the Central and Eastern European region, as were performed for early combination antiretroviral therapy (cART) [14].…”