Modeling the impact of HIV chemoprophylaxis strategies among men who have sex with men in the United States: HIV infections prevented and cost-effectiveness
Modeling the impact of HIV chemoprophylaxis strategies among men who have sex with men in the United States: HIV infections prevented and cost-effectiveness
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DOI：
10.1097/qad.0b013e32830e00f5
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发表时间：
2008-09-12
期刊：
影响因子：
3.8
通讯作者：
McElroy, Peter D.
中科院分区：
文献类型：
--
作者：
Desai, Kamal;Sansom, Stephanie L.;McElroy, Peter D.
背景与目的：艾滋病病毒（HIV）化学预防可能是一种有助于控制全球艾滋病流行的未来预防策略。目前两种药物的安全性和有效性试验正在进行中。我们评估了在美国一个大城市中男男性行为者（MSM）中假设的HIV化学预防项目所预防的HIV病例预期数量以及成本效益。
设计与方法：我们利用艾滋病监测数据建立了一个随机分区数学模型，以模拟艾滋病流行情况以及在流行病学、行为、项目和成本参数的不同假设下一个为期5年的化学预防项目的影响。我们从美国医疗保健系统的角度，与当前的艾滋病预防措施相比，估算了项目的有效性和成本。主要结局指标是预防的艾滋病感染数量以及每挽救一个质量调整生命年的增量成本。
结果：在纽约市针对25%的高危男男性行为者的化学预防项目，在5年内能够预防在纽约市所有男男性行为者中预计发生的19510例艾滋病感染中的780例（4%）到4510例（23%）。超过一半的预防感染将发生在那些未接受化学预防但因社区艾滋病患病率降低而受益的人群中。在基础案例假设下，每挽救一个质量调整生命年的增量成本为31970美元。在有效性、保护机制和依从性的大多数变化情况下，该项目具有成本效益。
结论：在美国一个主要城市的高危男男性行为者中进行艾滋病病毒化学预防能够预防大量艾滋病感染，并且具有成本效益。（C）2008年，威科集团（Wolters Kluwer Health）旗下的利平科特·威廉姆斯与威尔金斯出版公司（Lippincott Williams & Wilkins）
Background and objective: HIV chemoprophylaxis may be a future prevention strategy to help control the global epidemic of HIV/AIDS. Safety and efficacy trials of two agents are Currently underway. We assess the expected number of HIV cases prevented and cost-effectiveness of a hypothetical HIV chemoprophylaxis program among men who have sex with men in a large US city.Design and methods: We developed a stochastic compartmental mathematical model using HIV/AIDS surveillance data to simulate the HIV epidemic and the impact of a 5-year chemoprophylaxis program under varying assumptions for epidemiological, behavioral, programmatic and cost parameters. We estimated program effectiveness and costs from the perspective of the US healthcare system compared with current HIV prevention practices. The main outcome measures were number of HIV infections prevented and incremental cost per quality-adjusted life-years saved.Results: A chemoprophylaxis program targeting 25% of high-risk men who have sex with men in New York City could prevent 780 (4%) to 4510 (23%) of the 19 510 HIV infections predicted to occur among all men who have sex with men in New York City in 5 years. More than half of prevented infections would be among those not taking chemoprophylaxis but who benefit from reduced HIV prevalence in the community. Under base-case assumptions, incremental cost was US$ 31 970 per quality-adjusted life-years saved. The program was cost-effective under most variations in efficacy, mechanism of protection and adherence.Conclusion: HIV chemoprophylaxis among high-risk men who have sex with men in a major US city could prevent a significant number of HIV infections and be cost-effective. (C) 2008 Wolters Kluwer Health vertical bar Lippincott Williams & Wilkins.