The cost-effectiveness of preexposure prophylaxis for HIV prevention in the United States in men who have sex with men.
The cost-effectiveness of preexposure prophylaxis for HIV prevention in the United States in men who have sex with men.
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DOI：
10.7326/0003-4819-156-8-201204170-00001
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发表时间：
2012-04-17
影响因子：
39.2
通讯作者：
Bendavid E
中科院分区：
文献类型：
--
作者：
Juusola JL;Brandeau ML;Owens DK;Bendavid E
在最近的一项随机对照试验中，每日口服暴露前化学预防（PrEP）被证明对男性同性恋者（MSM）的艾滋病毒预防有效。美国疾病控制和预防中心（CDC）最近提供了在MSM中使用PrEP的临时指南，这些MSM具有获得艾滋病毒的高风险。以前的研究未能达到一致的估计其成本效益。评估PrEP在美国MSM中的有效性和成本效益。艾滋病毒传播和进展的动态模型结合详细的经济分析。出版的文献。美国13-64岁的MSM。辈子社交我们评估了一般MSM人群和高危MSM人群的PrEP。根据临床试验结果，我们假设PrEP可将感染风险降低44%。新的艾滋病毒感染，贴现的质量调整生命年（QELS）和成本，以及增量成本效益比。如果在美国20%的MSM中开始PrEP，我们估计新的艾滋病毒感染减少13%，20年内获得550，166个QALY，成本为172，091美元/QALY。在更大比例的MSM中启动PrEP可以避免更多的感染，但每QALY的成本增加（当100%的MSM接受PrEP时，每QALY增加216，480美元）。仅在高危MSM中使用PrEP可以提高其成本效益。PrEP费用约为50，000美元/QALY获得男男性接触者，平均每年有5名合作伙伴。为所有高风险男男性行为者提供20年的PrEP导致750亿美元的医疗保健相关成本增加到现状，每避免一次艾滋病毒感染的成本为60万美元，而为所有男男性行为者提供20%的覆盖率，每避免一次感染的成本为950亿美元和200万美元。如果PrEP的抗逆转录病毒药物的每日成本低于15美元，或者如果PrEP疗效大于75%，则在一般MSM人群中使用PrEP的成本低于10万美元/QALY。当检查PrEP在高风险MSM中的使用时，由于缺乏混合模式的数据，我们没有对低风险和高风险MSM之间的混合进行建模。在一般MSM人群中使用PrEP预防艾滋病毒可以预防大量艾滋病毒感染，但价格昂贵。PrEP在高风险MSM中的使用优于其他被认为具有成本效益的干预措施，但可能导致PrEP的年度支出超过40亿美元。
In a recent randomized controlled trial, daily oral preexposure chemoprophylaxis (PrEP) was shown to be effective for HIV prevention in men who have sex with men (MSM). The United States Centers for Disease Control and Prevention (CDC) recently provided interim guidance for PrEP use among MSM who are at high risk for acquiring HIV. Previous studies failed to reach a consistent estimate of its cost-effectiveness. To estimate the effectiveness and cost-effectiveness of PrEP in MSM in the United States. Dynamic model of HIV transmission and progression combined with a detailed economic analysis. Published literature. MSM aged 13–64 in the United States. Lifetime. Societal. We evaluated PrEP for the general MSM population and for high-risk MSM. We assumed that PrEP reduces infection risk by 44%, based on clinical trial results. New HIV infections, discounted quality-adjusted life-years (QALYs) and costs, and incremental cost-effectiveness ratios. If PrEP is initiated in 20% of MSM in the United States, we estimate a 13% reduction in new HIV infections and a gain of 550,166 QALYs over 20 years at a cost of $172,091/QALY gained. Initiating PrEP in a larger proportion of MSM averts more infections but at increasing cost per QALY gained ($216,480/QALY gained when 100% of MSM receive PrEP). Using PrEP only in high-risk MSM can improve its cost-effectiveness. PrEP costs approximately $50,000/QALY gained for MSM with 5 annual partners on average. PrEP for all high-risk MSM for 20 years leads to $75 billion in healthcare-related costs incremental to the status quo and costs $600,000 per HIV infection averted, compared with incremental costs of $95 billion and $2 million per infection averted for 20% coverage of all MSM. PrEP use in the general MSM population costs less than $100,000/QALY gained if the daily cost of antiretroviral drugs for PrEP is less than $15 or if PrEP efficacy is greater than 75%. When examining PrEP use in high-risk MSM, we did not model mixing between low- and high-risk MSM because of lack of data on mixing patterns. Use of PrEP for HIV prevention in the general MSM population could prevent a substantial number of HIV infections but is expensive. PrEP use in high-risk MSM compares favorably to other interventions considered cost-effective, but could result in annual expenditures on PrEP of over $4 billion.
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