Cost-Effectiveness Analysis of a National Pre-Exposure Prophylaxis (PrEP) Program in Ireland.
Value Health
; 24(7): 948-956, 2021 07.
Article
em En
| MEDLINE
| ID: mdl-34243838
ABSTRACT
OBJECTIVES:
To estimate the cost-effectiveness of introducing a publicly funded pre-exposure prophylaxis (PrEP) program in Ireland.METHODS:
We constructed a state-transition Markov model. This was a cross-sectional population model that tracked all HIV-negative men who have sex with men (MSM) in Ireland over their lifetime. Access to a publicly funded PrEP program (medications + frequent monitoring) in high-risk MSM was compared with no PrEP. The primary outcome measure was the incremental cost-effectiveness ratio (ICER).RESULTS:
In the base case, introducing a PrEP program was considered cost saving and provided significant health benefits to the population. Univariate sensitivity analysis demonstrated that PrEP efficacy and HIV incidence had the greatest impact on cost-effectiveness. Including an increase in sexually transmitted infections had a negligible impact on the results. Efficacy was a significant driver in the model. PrEP was cost saving at all efficacy values above 60%, and at the lowest reported efficacy in MSM (44% in the iPrEX trial), the ICER was 4711/QALY (highly cost-effective). Event-based dosing (administration during high-risk periods only) was associated with additional cost savings. We estimated that 1705 individuals (95% CI 617-3452) would join the program in year 1. The incremental budget impact was 1.5m (95% CI 0.5m to 3m) in the first year and 5.4m over 5 years (95% CI 1.8m to 11.5m), with 173 cases of HIV averted over 5 years.CONCLUSION:
We found that the introduction of a PrEP program would be considered cost saving in the first cost-effectiveness analysis of its kind in Ireland.Palavras-chave
Texto completo:
1
Base de dados:
MEDLINE
Assunto principal:
Infecções por HIV
/
Análise Custo-Benefício
/
Profilaxia Pré-Exposição
Tipo de estudo:
Evaluation_studies
/
Health_economic_evaluation
/
Observational_studies
/
Prevalence_studies
/
Risk_factors_studies
Limite:
Humans
/
Male
País como assunto:
Europa
Idioma:
En
Ano de publicação:
2021
Tipo de documento:
Article