Ong, KJ;
Desai, S;
Field, N;
Desai, M;
Nardone, A;
van Hoek, AJ;
Gill, ON;
(2017)
Economic evaluation of HIV pre-exposure prophylaxis among men-who-have-sex-with-men in England in 2016.
Euro Surveillance
, 22
(42)
, Article pii=17-00192. 10.2807/1560-7917.ES.2017.22.42.17-00192.
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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.
| Type: | Article |
|---|---|
| Title: | Economic evaluation of HIV pre-exposure prophylaxis among men-who-have-sex-with-men in England in 2016 |
| Location: | Sweden |
| Open access status: | An open access version is available from UCL Discovery |
| DOI: | 10.2807/1560-7917.ES.2017.22.42.17-00192 |
| Publisher version: | https://doi.org/10.2807/1560-7917.ES.2017.22.42.17... |
| Language: | English |
| Additional information: | This work is licensed under a Creative Commons Attribution 4.0 International License. The images or other third party material in this article are included in the article’s Creative Commons license, unless indicated otherwise in the credit line; if the material is not included under the Creative Commons license, users will need to obtain permission from the license holder to reproduce the material. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/ |
| Keywords: | Cost-effectiveness analysis, economic modelling, human immunodeficiency virus - HIV, men who have sex with men – MSM, pre-exposure prophylaxis - PrEP |
| UCL classification: | UCL UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute for Global Health UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute for Global Health > Infection and Population Health |
| URI: | https://discovery.ucl.ac.uk/id/eprint/10027896 |
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