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Abstract

Clinical effectiveness of pre-exposure prophylaxis (PrEP) for preventing HIV acquisition in men who have sex with men (MSM) at high HIV risk is established. A static decision analytical model was constructed to inform policy prioritisation in England around cost-effectiveness and budgetary impact of a PrEP programme covering 5,000 MSM during an initial high-risk period. National genitourinary medicine clinic surveillance data informed key HIV risk assumptions. Pragmatic large-scale implementation scenarios were explored. At 86% effectiveness, PrEP given to 5,000 MSM at 3.3 per 100 person-years annual HIV incidence, assuming risk compensation (20% HIV incidence increase), averted 118 HIV infections over remaining lifetimes and was cost saving. Lower effectiveness (64%) gave an incremental cost-effectiveness ratio of + GBP 23,500 (EUR 32,000) per quality-adjusted life year (QALY) gained. Investment of GBP 26.9 million (EUR 36.6 million) in year-1 breaks even anywhere from year-23 (86% effectiveness) to year-33 (64% effectiveness). PrEP cost-effectiveness was highly sensitive to year-1 HIV incidence, PrEP adherence/effectiveness, and antiretroviral drug costs. There is much uncertainty around HIV incidence in those given PrEP and adherence/effectiveness, especially under programme scale-up. Substantially reduced PrEP drug costs are needed to give the necessary assurance of cost-effectiveness, and for an affordable public health programme of sufficient size.

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/content/10.2807/1560-7917.ES.2017.22.42.17-00192
2017-10-19
2024-12-30
/content/10.2807/1560-7917.ES.2017.22.42.17-00192
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Economic evaluation of HIV pre-exposure prophylaxis among men-who-have-sex-with-men in England in 2016
<p class="citation"> <span>Citation style for this article:</span> <span class="meta-value authors"> <a href="/search?value1=Koh+Jun+Ong&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Ong Koh Jun</a>, <a href="/search?value1=Sarika+Desai&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Desai Sarika</a>, <a href="/search?value1=Nigel+Field&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Field Nigel</a>, <a href="/search?value1=Monica+Desai&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Desai Monica</a>, <a href="/search?value1=Anthony+Nardone&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Nardone Anthony</a>, <a href="/search?value1=Albert+Jan+van+Hoek&option1=author&noRedirect=true" class="nonDisambigAuthorLink">van Hoek Albert Jan</a>, <a href="/search?value1=Owen+Noel+Gill&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Gill Owen Noel</a></span>. Economic evaluation of HIV pre-exposure prophylaxis among men-who-have-sex-with-men in England in 2016. <a href="/content/ecdc">Euro Surveill.</a> 2017;22(42):pii=17-00192. <a href="https://doi.org/10.2807/1560-7917.ES.2017.22.42.17-00192" title="doi link" target="_blank">https://doi.org/10.2807/1560-7917.ES.2017.22.42.17-00192</a> <span class="ES_Article_citation"> <span class="generated">Received</span>: 13 Mar 2017;&nbsp;&nbsp; <span class="generated">Accepted</span>: 15 Aug 2017 </span> </p>
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