Cost-effectiveness analysis of the daily HIV pre-exposure prophylaxis in men who have sex with men in Barcelona

PLoS One. 2023 Jan 17;18(1):e0277571. doi: 10.1371/journal.pone.0277571. eCollection 2023.


Introduction: Pre-Exposure Prophylaxis (PrEP) for HIV prevention has been implemented in several countries. Previous literature has shown that its cost-effectiveness (and, under some specifications, cost-saving character) is dependent on the reduction in price due to generics, the time-horizon and its effectiveness. The intervention has never been studied in Catalonia after the approval of the PrEP, a territory with extensive implementation.

Methods: Economic evaluation of the implementation of HIV pre-exposition prophylaxis using administrative data from Men who have Sex with Men (MSM) who receive the treatment (at the generic price) compared with non-implementation. A deterministic compartmental model and a social perspective with a micro-costing approach over the time horizon 2022-2062 are used. A baseline 86% effectiveness of PrEP is assumed.

Results: Daily oral PrEP is found to be cost-saving: discounted savings in costs are attained after 16 years, and after 40 years they reach 81 million euros. In terms of health indicators, 10,322 additional discounted QALYs are generated by the intervention. Results are sensitive to sexual behavioral patterns among MSM, the price of PrEP (reduced if offered on-demand), its effectiveness and the discount rate.

Conclusions: The use and promotion of PrEP in Catalonia is predicted to result in substantial health and monetary benefits because of reductions in HIV infections. Short-term investments in the promotion of PrEP will result in important cost-savings in the long term.

MeSH terms

  • Anti-HIV Agents*
  • Cost-Benefit Analysis
  • Cost-Effectiveness Analysis
  • Drugs, Generic / therapeutic use
  • HIV Infections* / drug therapy
  • Homosexuality, Male
  • Humans
  • Male
  • Pre-Exposure Prophylaxis* / methods
  • Sexual and Gender Minorities*


  • Anti-HIV Agents
  • Drugs, Generic

Grants and funding

The author(s) received no specific funding for this work.