Economic evaluation of HIV pre-exposure prophylaxis among men-who-have-sex-with-men in England in 2016

Ong, Koh Jun; Desai, Sarika; Field, Nigel; Desai, Monica; Nardone, Anthony; Hoek, Albert Jan van; Gill, O N

doi:10.2807/1560-7917.es.2017.22.42.17-00192

Cited by 16 publications

(22 citation statements)

References 19 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…This changes, though, at higher PrEP coverage (25¢0%), where only HIV-diagnosed MSM and PrEP users will require improved screening to reach the elimination target. Importantly, the required HCV screening frequencies in all MSM groups for achieving elimination are less than their average frequency of HIV testing in the UK [25,26], suggesting that these increases in HCV testing should be feasible if done at the same time as existing HIV testing using the same blood samples.…”

Section: Discussionmentioning

confidence: 99%

“…This frequent HIV-testing means PrEP users are diagnosed before reaching chronic HIV infection [25]. Non-PrEP users who acquire acute HIV infection, firstly transition to undiagnosed HIV infection and are then diagnosed at current UK HIV-testing rates (2¢3 years between infection and diagnosis) [26]. Acute HIV is assumed to have elevated HIV transmission risk (26-fold) [27].…”

Section: Model Derivationmentioning

confidence: 99%

“…For each model fit, we then assume that over 2012À2017 there is an increase in: (1) proportion of HIV-diagnosed MSM on ART from 85% [32] to 98% [6]; (2) proportion of those on ART that are virally suppressed from 72% to 97%; and (3) HIV testing frequency from every 3¢2 years [33] to 2¢3 years [26]. The resulting model projections (Supplementary Figs.…”

Section: Baseline Model Calibrationmentioning

confidence: 99%

See 2 more Smart Citations

Scaling up screening and treatment for elimination of hepatitis C among men who have sex with men in the era of HIV pre-exposure prophylaxis

et al. 2020

Self Cite

View full text Add to dashboard Cite

Background: Routine HIV pre-exposure prophylaxis (PrEP) and HIV care appointments provide opportunities for screening men who have sex with men (MSM) for hepatitis C virus infection (HCV). However, levels of screening required for achieving the WHO elimination target of reducing HCV incidence by 90% by 2030 among all MSM are unknown. Methods: An HCV/HIV transmission model was calibrated to UK prevalence of HIV among MSM (4¢7%) and chronic HCV infection among HIV-positive MSM (9¢9%) and HIV-negative MSM (1.2%). Assuming 12¢5% coverage of PrEP among HIV-negative MSM, we evaluated the relative reduction in overall HCV incidence by 2030 (compared to 2018 levels) of HCV screening every 12/6-months (alongside completing direct acting antiviral treatment within 6-months of diagnosis) in PrEP users and/or HIV-diagnosed MSM. We estimated the additional screening required among HIV-negative non-PrEP users to reduce overall incidence by 90% by 2030. The effect of 50% reduction in condom use among PrEP users (risk compensation) was estimated. Results: Screening and treating PrEP users for HCV every 12 or 6-months decreases HCV incidence by 67¢3% (uncertainty range 52¢7À79¢2%) or 70¢2% (57¢1À80¢8%), respectively, increasing to 75¢4% (59¢0À88¢6%) or 78¢8% (63¢9À90¢4%) if HIV-diagnosed MSM are also screened at same frequencies. Risk compensation reduces these latter projections by <10%. To reduce HCV incidence by 90% by 2030 without risk compensation, HIVnegative non-PrEP users require screening every 5¢6 (3¢8À9¢2) years if MSM on PrEP and HIV-diagnosed MSM are screened every 6-months, shortening to 4¢4 (3¢1À6¢6) years with risk compensation. For 25¢0% PrEP coverage, the HCV elimination target can be reached without screening HIV-negative MSM not on PrEP, irrespective of risk compensation. Interpretation: At low PrEP coverage, increased screening of all MSM is required to achieve the WHO HCVelimination targets for MSM in the UK, whereas at higher PrEP coverage this is possible through just screening HIV-diagnosed MSM and PrEP users.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Model Derivationmentioning

confidence: 99%

Section: Baseline Model Calibrationmentioning

confidence: 99%

See 1 more Smart Citation

Scaling up screening and treatment for elimination of hepatitis C among men who have sex with men in the era of HIV pre-exposure prophylaxis

et al. 2020

Self Cite

View full text Add to dashboard Cite

show abstract

“…PrEP was found to be cost-effective in the USA [16] and Peru [47] and in Australia in discordant regular partnerships [48]. Cost-savings (ie: savings due to decreases in treatment costs outweigh the intervention costs) were reported from the UK [40,49].…”

Section: Discussionmentioning

confidence: 99%

Cost utility analysis of HIV pre exposure prophylaxis among men who have sex with men in Israel

Ginsberg¹,

Chemtob²

2020

BMC Public Health

View full text Add to dashboard Cite

Background: Between 2011 and 2015, Men who have sex with men (MSM) accounted for nearly half of new HIV cases among men in Israel. This study carries out a cost-utility analysis of PrEP (HIV Pre Exposure Prophylaxis), an antiretroviral medication that can protect against the acquisition of HIV infection, whose incidence rate in Israel is around 1.74 per 1000 MSM. Method: Epidemiological, demographic, health service utilisation and economic data were integrated into a spread-sheet model in order to calculate the cost per averted disability-adjusted life year (DALY) of the intervention from a societal perspective, in mid-2018 US$ using a 3% discount rate. Cost utility analyses were performed for both types of PrEP delivery (continuous regimen and on-demand), together with sensitivity analyses on numbers of condom users who take up PrEP (baseline 25%) and subsequently abandon condom use (baseline 75%), PrEP efficacy (baseline 86%), PrEP prices and monitoring costs. Results: Around 21.3% of MSM are high risk (as defined by having unprotected anal intercourse). Offering PrEP to this group would have a ten year net cost of around 1563 million USD, preventing 493 persons from becoming HIV-positive, averting around 1616 DALYs at a cost per averted DALY of around 967,744 USD. This will render the intervention to be not cost-effective. PrEP drug prices would have to fall dramatically (by 90.7%) for the intervention to become cost-effective (i.e. having a cost per averted DALY less than thrice GNP per capita) in Israel. PrEP remains not cost-effective (at 475,673 USD per averted DALY) even if intervention costs were reduced by using an "on demand" instead of a daily schedule. Even if there were no changes in condom use, the resultant 411,694 USD cost-utility ratio is still not cost-effective. Conclusions: Despite PrEPs high effectiveness against HIV, PrEP was found not to be cost-effective in the Israeli context because of a combination of relatively low HIV incidence, high PrEP costs, with a likelyhood that some lowrisk MSM (ie: who use condoms) may well begin taking PrEP and as a consequence many of these will abandon condom use. Therefore, ways of minimizing these last two phenomena need to be found.

show abstract

“…Decision‐makers weigh population‐level tradeoffs for opportunities that offer small benefits to a large number of individuals or large benefits to a small number of individuals. For an affordable public health programme, substantially reduced drug prices will likely be needed .…”

Section: Introductionmentioning

confidence: 99%

Competing biomedical HIV prevention strategies: potential cost‐effectiveness of HIV vaccines and PrEP in Seattle, WA

et al. 2019

View full text Add to dashboard Cite

Introduction Promising HIV vaccine candidates are steadily progressing through the clinical trial pipeline. Once available, HIV vaccines will be an important complement but also potential competitor to other biomedical prevention tools such as pre‐exposure prophylaxis (PrEP). Accordingly, the value of HIV vaccines and the policies for rollout may depend on that interplay and tradeoffs with utilization of existing products. In this economic modelling analysis, we estimate the cost‐effectiveness of HIV vaccines considering their potential interaction with PrEP and condom use. Methods We developed a dynamic model of HIV transmission among the men who have sex with men population (MSM), aged 15‐64 years, in Seattle, WA offered PrEP and HIV vaccine over a time horizon of 2025‐2045. A healthcare sector perspective with annual discount rate of 3% for costs (2017 USD) and quality‐adjusted life years (QALYs) was used. The primary economic endpoint is the incremental cost‐effectiveness ratio (ICER) when compared to no HIV vaccine availability. Results HIV vaccines improved population health and increased healthcare costs. Vaccination campaigns achieving 90% coverage of high‐risk men and 60% coverage of other men within five years of introduction are projected to avoid 40% of new HIV infections between 2025 and 2045. This increased total healthcare costs by $30 million, with some PrEP costs shifted to HIV vaccine spending. HIV vaccines are estimated to have an ICER of $42,473/QALY, considered cost‐effective using a threshold of $150,000/QALY. Results were most sensitive to HIV vaccine efficacy and future changes in the cost of PrEP drugs. Sensitivity analysis found ranges of 30‐70% HIV vaccine efficacy remained cost‐effective. Results were also sensitive to reductions in condom use among PrEP and vaccine users. Conclusions Access to an HIV vaccine is desirable as it could increase the overall effectiveness of combination HIV prevention efforts and improve population health. Planning for the rollout and scale‐up of HIV vaccines should carefully consider the design of policies that guide interactions between vaccine and PrEP utilization and potential competition.

show abstract

Economic evaluation of HIV pre-exposure prophylaxis among men-who-have-sex-with-men in England in 2016

Cited by 16 publications

References 19 publications

Scaling up screening and treatment for elimination of hepatitis C among men who have sex with men in the era of HIV pre-exposure prophylaxis

Scaling up screening and treatment for elimination of hepatitis C among men who have sex with men in the era of HIV pre-exposure prophylaxis

Cost utility analysis of HIV pre exposure prophylaxis among men who have sex with men in Israel

Competing biomedical HIV prevention strategies: potential cost‐effectiveness of HIV vaccines and PrEP in Seattle, WA

Contact Info

Product

Resources

About