RESUMO
OBJECTIVE: :Mass screening for human immunodeficiency virus (HIV) and preexposure prophylaxis (PrEP) may be effective measures for reducing the probability of HIV transmission. Our study aimed to determine the cost-effectiveness of preliminary screening in the general population, PrEP for HIV-negative spouses in serodiscordant couples, or both approaches in Zhejiang Province. DESIGN: :From a policy-maker's perspective, a Markov model was constructed to compare 4 strategies over a 30-year horizon. METHODS: :In the Markov model, the implementation intensities of the strategies varied from 50% to 100%. Different strategies were evaluated by the reduction of unfavorable clinical outcomes, saved life-years (LYs), quality-adjusted life-years (QALYs), incremental cost-effectiveness ratios (ICERs), and net monetary benefits (NMBs). RESULTS: :The PrEP-Screening strategy reduced the most unfavorable clinical outcomes and saved the most LYs and QALYs from 2023 to 2052. It always gained the maximum QALYs and NMB, while its ICER was always lower than the willingness-to-pay (WTP). The NMB of the PrEP-Screening strategy gradually increased as the implementation intensity increased. CONCLUSIONS: :With adequate manpower and policies, we suggest implementing the PrEP-Screening strategy in Zhejiang Province, suggesting that the broader the population coverage of the strategy, the better. In addition, the PrEP strategy is an alternative.