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COST-EFFECTIVENESS OF THREE DIFFERENT PRE-EXPOSURE PROPHYLAXIS (PREP) REGIMENS FOR HIV PREVENTION IN MEXICO
Titulo alternativo
Custo-efetividade de três regimes diferentes de profilaxia de pré-exposição (Prep) para prevenção do HIV no MéxicoAutor
Afiliación
Instituto Nacional de Ciencias Medicas y Nutrición Salvador Zubirán. Infectious Diseases. Mexico City, Mexico.
Instituto Nacional de Salud Pública. Cuernavaca, Mexico.
Instituto Nacional de Salud Pública. Cuernavaca, Mexico.
Instituto Nacional de Ciencias Medicas y Nutrición Salvador Zubirán. Infectious Diseases. Mexico City, Mexico.
Instituto Nacional de Ciencias Medicas y Nutrición Salvador Zubirán. Infectious Diseases. Mexico City, Mexico.
Instituto Nacional de Ciencias Medicas y Nutrición Salvador Zubirán. Infectious Diseases. Mexico City, Mexico.
Consorcio de Investigación en Salud (CISIDAT). Cuernavaca, Mexico.
Fundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Laboratório de Pesquisa Clínica em DST/AIDS. Rio de Janeiro, RJ, Brasil.
Fundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Laboratório de Pesquisa Clínica em DST/AIDS. Rio de Janeiro, RJ, Brasil.
London School of Hygiene and Tropical Medicine. London, United Kingdom.
Instituto Nacional de Salud Pública. Cuernavaca, Mexico.
Instituto Nacional de Salud Pública. Cuernavaca, Mexico.
Instituto Nacional de Ciencias Medicas y Nutrición Salvador Zubirán. Infectious Diseases. Mexico City, Mexico.
Instituto Nacional de Ciencias Medicas y Nutrición Salvador Zubirán. Infectious Diseases. Mexico City, Mexico.
Instituto Nacional de Ciencias Medicas y Nutrición Salvador Zubirán. Infectious Diseases. Mexico City, Mexico.
Consorcio de Investigación en Salud (CISIDAT). Cuernavaca, Mexico.
Fundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Laboratório de Pesquisa Clínica em DST/AIDS. Rio de Janeiro, RJ, Brasil.
Fundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Laboratório de Pesquisa Clínica em DST/AIDS. Rio de Janeiro, RJ, Brasil.
London School of Hygiene and Tropical Medicine. London, United Kingdom.
Resumen en ingles
Background: Pre-exposure prophylaxis (PrEP) can be cost-effective in populations at high risk of HIV. While PrEP is the standard of care in Mexico, evidence of its cost-effectiveness is lacking. Therefore, we analysed the cost-effectiveness of PrEP among men who have sex with men (MSM) and transgender women (TGW). Methods: We developed a Markov model to examine the impact of scaling up PrEP through government and community clinics in MSM and TGW 15 years at high risk of HIV. Primary analysis evaluated generic emtricitabine-tenofovir disoproxil fumarate (F/TDF), branded emtricitabine-tenofovir alafenamide (F/TAF), and long-acting cabotegravir (CAB-LA) versus no-PrEP. Secondary analysis assessed F/TAF and CAB-LA versus F/TDF. The model was analysed from the healthcare perspective in a 15-year horizon (2022-2036). Incremental cost per quality-adjusted life-year (QALY) was compared against the national cost-effectiveness threshold (CET) of $10,165 per QALY gained. We varied key parameters in sensitivity analyses. Results: Annual costs of F/TDF, F/TAF and CAB-LA were $1,384, $2,220, and $1,384, respectively. If PrEP was scaled-up at 30% coverage and 80% uptake, F/TDF would avert 57,150 HIV transmissions and yield 138,892 incremental QALYs with an additional cost of $60 million compared with no-PrEP. F/TAF and CAB-LA would avert 55,000 HIV transmissions, achieving 134,018 and 133,951 incremental QALYs with additional $1.6 and $1.2 billion costs, respectively. Compared with no-PrEP, the incremental cost-effectiveness ratio (ICER) of F/TDF, F/TAF and CAB-LA were $4,427, $12,216, and $8,955 per QALY gained, with an 89%, 30% and 63% probability of cost-effectiveness (figure 1), respectively. F/TAF and CAB-LA were dominated by F/TDF. Results were robust to sensitivity analyses. Compared with F/TDF, CAB-LA was cost-effective at a maximum price of $788 and in populations with higher HIV incidence.
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