Background Pre-exposure prophylaxis (PrEP) is highly effective in reducing HIV transmission among men who have sex with men (MSM). We investigated the impact of daily and event-driven PrEP on the transmission of HIV and N. gonorrhoeae (NG) and its cost-effectiveness in the Netherlands.
Methods We developed a stochastic agent-based transmission model of HIV and NG among MSM. We simulated three scenarios: (1) No PrEP; (2) Offering daily and event-driven PrEP; (3) Offering only daily PrEP. Three-monthly PrEP monitoring included testing for HIV, gonorrhoea, and other infections. From the Amsterdam PrEP Demonstration Project (AMPrEP) data, it was estimated that 27% of PrEP users prefer event-driven PrEP and they use half the amount of PrEP pills used by daily users. We assumed PrEP effectiveness was 86% regardless of regimen. Simulated outcomes of the transmission model were used in an economic model to calculate costs, quality-adjusted life-years (QALY), and incremental cost-effectiveness ratios (ICER), over 2018–2027, taking a healthcare payer perspective. An ICER less than €20,000 per QALY gained was considered cost-effective.
Results PrEP resulted in 3,486 HIV infections averted and 1,482 QALYs gained over 2018–2027. Gonorrhoea prevalence dropped from 0.782% in 2017 to 0.023% in 2027. When offering both daily and event-driven PrEP, the costs for PrEP medication were €19 million over 2018–2027. This resulted in less total costs than when no PrEP is offered, making this programme cost-saving. With only daily PrEP, the costs for PrEP medication were €22 million over 2018–2027, making this programme cost-effective with a mean ICER of €217.40 per QALY gained.
Conclusion The PrEP programme (including STI monitoring) can be effective in reducing HIV incidence and gonorrhoea prevalence among MSM and can be cost-effective, even if all PrEP users prefer the daily regime. Monitoring of PrEP users can result in reductions in prevalence of STIs being monitored. Acknowledgements: AIDSfonds (2014037), ZonMw (522002003).
Disclosure No significant relationships.
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