Daily Oral Human Immunodeficiency Virus (HIV) Pre-exposure Prophylaxis Among Young Men Who Have Sex With Men in the United States: Cost-saving at Generic Drug Price

被引：2

作者：

Amick, Alyssa K. ^{[1
]}

Eskibozkurt, G. Ege ^{[1
]}

Hosek, Sybil G. ^{[2
]}

Flanagan, Clare F. ^{[1
]}

Landovitz, Raphael J. ^{[3
]}

Jin, Elena Y. ^{[1
]}

Wilson, Craig M. ^{[4
]}

Freedberg, Kenneth A. ^{[1
,5
,6
,7
,8
]}

Weinstein, Milton C. ^{[8
]}

Kazemian, Pooyan ^{[9
]}

Paltiel, A. David ^{[10
]}

Ciaranello, Andrea L. ^{[1
,5
,7
]}

Neilan, Anne M. ^{[1
,5
,7
,11
]}

机构：

[1] Massachusetts Gen Hosp, Med Practice Evaluat Ctr, Boston, MA 02114 USA

[2] John H Stroger Jr Hosp Cook Cty, Chicago, IL USA

[3] UCLA, Ctr Clin AIDS Res & Educ, Los Angeles, CA USA

[4] Univ Alabama Birmingham, Dept Epidemiol, Birmingham Sch Publ Hlth, Birmingham, AL USA

[5] Massachusetts Gen Hosp, Dept Med, Div Infect Dis, Boston, MA 02114 USA

[6] Massachusetts Gen Hosp, Dept Med, Div Gen Internal Med, Boston, MA USA

[7] Harvard Med Sch, Boston, MA 02115 USA

[8] Harvard T H Chan Sch Publ Hlth, Dept Hlth Policy & Management, Boston, MA USA

[9] Case Western Reserve Univ, Weatherhead Sch Management, Cleveland Hts, OH USA

[10] Yale Sch Publ Hlth, Dept Hlth Policy & Management, New Haven, CT USA

[11] Massachusetts Gen Hosp, Dept Pediat, Div Gen Acad Pediat, Boston, MA 02114 USA

来源：

CLINICAL INFECTIOUS DISEASES | 2024年 / 78卷 / 02期

基金：

美国国家卫生研究院;

关键词：

YMSM; youth; HIV; pre-exposure prophylaxis; cost-effectiveness; DOUBLE-BLIND; INFECTION; DOLUTEGRAVIR; RISK; PREVENTION; LAMIVUDINE; RETENTION; ABACAVIR; SAFETY; ADULTS;

D O I：

10.1093/cid/ciad566

中图分类号：

R392 [医学免疫学]; Q939.91 [免疫学];

学科分类号：

100102 ;

摘要：

Background Adherence and retention concerns raise questions about the effectiveness and cost-effectiveness of oral HIV pre-exposure prophylaxis (PrEP) in young men who have sex with men (YMSM).Methods Using an adolescent-focused simulation model, we compared annual HIV screening alone with tenofovir disoproxil fumarate/emtricitabine-based oral PrEP with every 3-month HIV screening in YMSM (aged 15-24) at increased risk of HIV. Data derived from published sources included: age-stratified HIV incidence/100 person-years (PY) on- or off-PrEP (0.6-10.1 or 0.4-6.4), PrEP retention at 6 years (28%), transmissions by HIV RNA level (0.0-78.4/100PY) and annual costs of antiretroviral therapy ($32 000-69 000), HIV care ($3100-34 600), and PrEP program/generic drug ($900/360). Outcomes included transmissions (percent of cohort infected), quality-adjusted life-years (QALYs), costs ($), and incremental cost-effectiveness ratios ($/QALY). We explored the sensitivity of findings to variation in HIV incidence and drug prices.Results Compared with annual screening alone, PrEP would increase QALYs (9.58 to 9.67), reduce new infections (37% to 30%), and decrease costs (by $5000) over 10 years. PrEP would remain cost-saving for HIV incidence off-PrEP >= 5.1/100PY or annual PrEP price <=$1200. Over a lifetime horizon, PrEP would be cost-saving for HIV incidence off-PrEP >= 1.0/100PY, across all retention assumptions examined. PrEP would not be cost-effective at HIV incidence <= 0.1/100PY, regardless of drug price, due to programmatic costs.Conclusions In US YMSM at increased risk of HIV, generic oral PrEP and every-3-month screening would be cost-saving compared with annual screening alone, even with high discontinuation and low adherence, over a range of HIV incidences. An adolescent-focused simulation model projected that generic daily oral HIV pre-exposure prophylaxis and every-3-month HIV screening would be cost-saving compared with annual HIV screening alone among young men who have sex with men at increased risk of HIV infection.

引用

页码：402 / 410

页数：9