Cost-effectiveness analysis of pre-exposure prophylaxis for HIV-1 prevention in the Netherlands: a mathematical modelling study

Lancet Infect Dis. 2016 Dec;16(12):1423-1429. doi: 10.1016/S1473-3099(16)30311-5. Epub 2016 Sep 22.

Abstract

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.

Findings: 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%.

Interpretation: 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.

Funding: None.

MeSH terms

  • Anti-HIV Agents / economics
  • Anti-HIV Agents / therapeutic use*
  • Cost-Benefit Analysis*
  • Emtricitabine / economics
  • Emtricitabine / therapeutic use
  • HIV Infections / drug therapy*
  • HIV-1 / isolation & purification
  • Homosexuality, Male
  • Humans
  • Male
  • Models, Theoretical
  • Netherlands
  • Pre-Exposure Prophylaxis / methods*
  • Tenofovir / economics
  • Tenofovir / therapeutic use

Substances

  • Anti-HIV Agents
  • Tenofovir
  • Emtricitabine