Potential Clinical and Economic Value of Long-Acting Preexposure Prophylaxis for South African Women at High-Risk for HIV Infection
Potential Clinical and Economic Value of Long-Acting Preexposure Prophylaxis for South African Women at High-Risk for HIV Infection
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DOI：
10.1093/infdis/jiv523
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发表时间：
2016-05-15
影响因子：
6.4
通讯作者：
Paltiel，A. David
中科院分区：
文献类型：
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作者：
Walensky，Rochelle P.;Jacobsen，Margo M.;Paltiel，A. David
背景：对于有感染人类免疫缺陷病毒（HIV）风险的年轻南非妇女，暴露前预防（PrEP）是为数不多的有效预防选择之一。长效注射PrEP，这是在开发中，可能与更大的坚持，与现有的标准口服PrEP制剂相比，但其可能的临床效益和额外的成本是未知的。方法：使用计算机模拟，我们比较了以下3个PrEP策略：无PrEP，标准PrEP（有效性，62%;每位患者的成本，150美元/年），和长效PrEP（有效性，75%;每位患者的成本，220美元/年）在南非妇女中处于HIV感染的高风险（HIV感染率，5%/年）。我们检查了策略对几个结果指标中关键输入参数变化的敏感性，包括5年内避免的死亡和项目成本;终生艾滋病毒感染风险、存活率和项目成本和成本效益;结果：与没有PrEP相比，标准PrEP和长效PrEP分别使每位妇女多花费580美元和870美元，在5年内，每1 000名高危感染妇女中分别避免了15人和16人死亡。在生命周期的基础上进行测量，与没有PrEP相比，标准PrEP和长效PrEP都节省了成本。与标准PrEP相比，长效PrEP非常具有成本效益（150美元/生命年节省），除非在最悲观的假设下。超过5年，长效PrEP成本$1.6十亿时提供给50%的符合条件的women.Conclusions.目前可用的标准PrEP是一种节省成本的干预措施，其交付应扩大和优化。与标准PrEP相比，长效PrEP可能是一种非常具有成本效益的改进，但可能需要新的融资机制，使短期财政规划工作与长期社会目标更加一致。
Background.For young South African women at risk for human immunodeficiency virus (HIV) infection, preexposure prophylaxis (PrEP) is one of the few effective prevention options available. Long-acting injectable PrEP, which is in development, may be associated with greater adherence, compared with that for existing standard oral PrEP formulations, but its likely clinical benefits and additional costs are unknown.Methods.Using a computer simulation, we compared the following 3 PrEP strategies: no PrEP, standard PrEP (effectiveness, 62%; cost per patient, $150/year), and long-acting PrEP (effectiveness, 75%; cost per patient, $220/year) in South African women at high risk for HIV infection (incidence of HIV infection, 5%/year). We examined the sensitivity of the strategies to changes in key input parameters among several outcome measures, including deaths averted and program cost over a 5-year period; lifetime HIV infection risk, survival rate, and program cost and cost-effectiveness; and budget impact.Results.Compared with no PrEP, standard PrEP and long-acting PrEP cost $580 and $870 more per woman, respectively, and averted 15 and 16 deaths per 1000 women at high risk for infection, respectively, over 5 years. Measured on a lifetime basis, both standard PrEP and long-acting PrEP were cost saving, compared with no PrEP. Compared with standard PrEP, long-acting PrEP was very cost-effective ($150/life-year saved) except under the most pessimistic assumptions. Over 5 years, long-acting PrEP cost $1.6 billion when provided to 50% of eligible women.Conclusions.Currently available standard PrEP is a cost-saving intervention whose delivery should be expanded and optimized. Long-acting PrEP will likely be a very cost-effective improvement over standard PrEP but may require novel financing mechanisms that bring short-term fiscal planning efforts into closer alignment with longer-term societal objectives.