Cost-effectiveness of alternative strategies for provision of HIV preexposure prophylaxis for people who inject drugs.
AIDS
; 32(5): 663-672, 2018 03 13.
Article
in En
| MEDLINE
| ID: mdl-29334549
ABSTRACT
BACKGROUND:
Oral HIV preexposure prophylaxis (PrEP) has been recommended as a means of HIV prevention among people who inject drugs (PWIDs) but, at current prices, is unlikely to be cost-effective for all PWID.OBJECTIVE:
To determine the cost-effectiveness of alternative strategies for enrolling PWID in PrEP.DESIGN:
Dynamic network model that captures HIV transmission and progression among PWID in a representative US urban center. OUTCOMEMEASURES:
HIV infections averted, discounted costs and quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratios. INTERVENTION We assume 25% PrEP coverage and investigate four strategies first, random PWID are enrolled (Unselected Enrollment); second, individuals are randomly selected and enrolled together with their partners (Enroll Partners); third, individuals with the highest number of sexual and needle-sharing partnerships are enrolled (Most Partners); fourth, individuals with the greatest number of infected partners are enrolled (Most Positive Partners).RESULTS:
PrEP can achieve significant health benefits compared with 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 incremental cost-effectiveness ratio of each strategy compared with the status quo (cost per QALY gained) is $272â000 (Unselected Enrollment), $158â000 (Enroll Partners), $124â000 (Most Partners), and $101â000 (Most Positive Partners). All strategies except Unselected Enrollment are cost-effective according to WHO criteria.CONCLUSION:
Selection of high-risk PWID for PrEP can improve the cost-effectiveness of PrEP for PWID.
Full text:
1
Collection:
01-internacional
Database:
MEDLINE
Main subject:
HIV Infections
/
Substance Abuse, Intravenous
/
Cost-Benefit Analysis
/
Disease Transmission, Infectious
/
Pre-Exposure Prophylaxis
Type of study:
Health_economic_evaluation
/
Prognostic_studies
Aspects:
Patient_preference
Limits:
Adult
/
Female
/
Humans
/
Male
Language:
En
Journal:
AIDS
Journal subject:
SINDROME DA IMUNODEFICIENCIA ADQUIRIDA (AIDS)
Year:
2018
Document type:
Article