Cost-effectiveness analysis of pre-exposure prophylaxis for HIV-1 prevention in the Netherlands: a mathematical modelling study.
BACKGROUND
Pre-exposure prophylaxis (PrEP) with tenofovir and emtricitabine prevents HIV infections among men who have sex with men (MSM). PrEP can be given on a daily or intermittent basis. Unfortunately, PrEP is not reimbursed in most European countries. Cost-effectiveness analyses of PrEP among MSM in Europe are absent but are key for decision makers to decide upon PrEP implementation.


METHODS
We developed a deterministic mathematical model, calibrated to the well defined Dutch HIV epidemic among MSM, to predict the effect and cost-effectiveness of PrEP. PrEP was targeted to 10% of highly sexually active Dutch MSM over the coming 40 years. Cost-effectiveness ratios were calculated to predict the cost-effectiveness of daily and on-demand PrEP. Cost-effectiveness ratios below €20 000 were considered to be cost-effective in this analysis.


RESULTS
Within the context of a stable HIV epidemic, at 80% effectiveness and current PrEP pricing, PrEP can cost as much as €11 000 (IQR 9400-14 100) per quality-adjusted life-year (QALY) gained when used daily, or as little as €2000 (IQR 1300-3000) per QALY gained when used on demand. At 80% effectiveness, daily PrEP can be considered cost-saving if the price of PrEP is reduced by 70%, and on-demand PrEP can be considered cost-saving if the price is reduced by 30-40%.


CONCLUSIONS
PrEP for HIV prevention among MSM in the Netherlands is cost-effective. The use of PrEP is most cost-effective when the price of PrEP is reduced through on-demand use or through availability of generic PrEP, and can quickly be considered cost-saving.


BACKGROUND
None.
Department of Viroscience, Erasmus Medical Center, Rotterdam, Netherlands. Electronic address: b.nichols@erasmusmc.nl.
Brooke E
BE
Nichols
Department of Viroscience, Erasmus Medical Center, Rotterdam, Netherlands.
Charles A B
CAB
Boucher
Department of Internal Medicine, Division of Infectious Diseases, Center for Infection and Immunity Amsterdam, Academic Medical Center, Amsterdam, Netherlands.
Marc
M
van der Valk
Department of Internal Medicine, Section Infectious Diseases, Erasmus Medical Center, Rotterdam, Netherlands.
Bart J A
BJA
Rijnders
Department of Viroscience, Erasmus Medical Center, Rotterdam, Netherlands.
David A M C
DAMC
van de Vijver
D019380:Anti-HIV Agents / Q000191:economics / Q000627:therapeutic use*; D003362:Cost-Benefit Analysis; D000068679:Emtricitabine / Q000191:economics / Q000627:therapeutic use; D015658:HIV Infections / Q000188:drug therapy*; D015497:HIV-1 / Q000302:isolation & purification; D018451:Homosexuality, Male; D006801:Humans; D008297:Male; D008962:Models, Theoretical; D009426:Netherlands; D065129:Pre-Exposure Prophylaxis / Q000379:methods*; D000068698:Tenofovir / Q000191:economics / Q000627:therapeutic use
D019380:Anti-HIV Agents; D000068698:Tenofovir; D000068679:Emtricitabine