Cost-effectiveness of alternative strategies for provision of HIV preexposure prophylaxis for people who inject drugs.
Cost-effectiveness of alternative strategies for provision of HIV preexposure prophylaxis for people who inject drugs.
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DOI：
10.1097/qad.0000000000001747
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发表时间：
2018-03-13
期刊：
影响因子：
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通讯作者：
Brandeau ML
中科院分区：
文献类型：
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作者：
Fu R;Owens DK;Brandeau ML
口服艾滋病毒暴露前预防（PrEP）已被推荐为注射吸毒者（PWID）预防艾滋病毒的一种手段，但以目前的价格，不太可能对所有PWID具有成本效益。为了确定将PWID纳入PrEP的替代策略的成本效益。动态网络模型捕获美国代表性城市中心PWID中HIV传播和进展。避免艾滋病毒感染，折扣成本和质量调整生命年（QALYs）以及增量成本效益比（ICERs）。我们假设PrEP覆盖率为25%，并研究了四种策略：1)随机入组PWID（未选择入组）；2)随机选择个人并与其合作伙伴（注册合作伙伴）一起注册；3)登记的性伙伴和共用针头伙伴人数最多（大多数伙伴）；4)登记受感染伴侣人数最多的个人（最阳性伴侣）。PrEP可以实现显著的健康效益：与不进行PrEP的现状相比，这些策略在20年期间获得了1114个QALYs（未选择入组）、2194个QALYs（注册合作伙伴）、2481个QALYs（大多数合作伙伴）和3046个QALYs（最积极的合作伙伴）。与现状相比，每种策略的ICER（获得的每质量aly成本）分别为272,000美元（未选择注册）、158,000美元（注册合作伙伴）、124,000美元（大多数合作伙伴）和101,000美元（最积极合作伙伴）。根据世卫组织标准，除非选择性入组外，所有策略都具有成本效益。选择高危PWID进行PrEP可提高PrEP治疗PWID的成本效益。
Oral HIV pre-exposure prophylaxis (PrEP) has been recommended as a means of HIV prevention among people who inject drugs (PWID) but, at current prices, is unlikely to be cost-effective for all PWID. To determine the cost-effectiveness of alternative strategies for enrolling PWID in PrEP. Dynamic network model that captures HIV transmission and progression among PWID in a representative US urban center. HIV infections averted, discounted costs and quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratios (ICERs). We assume 25% PrEP coverage and investigate four strategies: 1) random PWID are enrolled (Unselected Enrollment); 2) individuals are randomly selected and enrolled together with their partners (Enroll Partners); 3) individuals with the highest number of sexual and needle-sharing partnerships are enrolled (Most Partners); 4) individuals with the greatest number of infected partners are enrolled (Most Positive Partners). PrEP can achieve significant health benefits: compared to the status quo of no PrEP, the strategies gain 1114 QALYs (Unselected Enrollment), 2194 QALYs (Enroll Partners), 2481 QALYs (Most Partners), and 3046 QALYs (Most Positive Partners) over 20 years in a population of approximately 8500 people. The ICER of each strategy compared to the status quo (cost per QALY gained) is $272,000 (Unselected Enrollment), $158,000 (Enroll Partners), $124,000 (Most Partners), and $101,000 (Most Positive Partners). All strategies except Unselected Enrollment are cost-effective according to WHO criteria. Selection of high risk PWID for PrEP can improve the cost-effectiveness of PrEP for PWID.