Can we afford to offer pre-exposure prophylaxis to MSM in Catalonia? Cost-effectiveness analysis and budget impact assessment

Abstract

Pre-exposure prophylaxis (PrEP) effectiveness has been well established. This study aims to assess the cost-effectiveness of providing PrEP, estimate the number of eligible MSM, and its budget impact in Catalonia. Cost-effectiveness analysis compared costs of on daily basis and "on demand" PrEP to prevent one infection with lifetime costs of one HIV infection. We estimated the total cost of providing PrEP by estimating number of eligible MSM, and included in the budget impact assessment antiretroviral and laboratory costs. Costs were lower for the on-demand PrEP group by €64015.1 and the incremental benefit was nearly 15 life-years and 17 quality-adjusted life-years gained. The incremental cost-effectiveness ratio (ICER) was cost-effective at €6281.62 when undiscounted PrEP was given daily. On-demand PrEP can be considered cost-saving in 20 years if the price is reduced by 90%. The number of eligible MSM in Catalonia ranges from 5,989 to 10,972. At current antiretroviral costs, the annual cost would range between €25.3-46.7 million/year (on demand PrEP), and €42.9-78.7 million/year (daily basis PrEP). PrEP is most cost-effective if targeted towards groups with high incidence rates of over 3%/year. Beneficial ICER depends on reducing the current price of Truvada® and ensuring that effectiveness is maintained at high levels.

Evaluating the Cost-Effectiveness of a Pre-Exposure Prophylaxis Program for HIV Prevention for Men Who Have Sex with Men in Japan

“…Third, we conducted budget impact analysis in addition to cost-effectiveness analysis. Considering the number of MSM, our budget impact analysis demonstrated a similar result to previous studies 24 . We found introduction of PrEP program in Japan was expected to cost 708.2-897.3 million USD; this means that PrEP is an affordable intervention in Japan because national medical expenses amount to over 363.6 billion USD 25 and the cost of PrEP is likely to be covered by out-of-pocket expenses if it is approved.…”

“…Because medical checkups are required when taking PrEP, we used this proportion as the proportion eligible for PrEP. We also calculated the proportion eligible for PrEP using criteria used in other countries 24,46,47 . Using data from the same survey, we assumed that 70.0% of these men were willing to use PrEP.…”

Epidemiologic and Economic Analysis of Rapid Antiretroviral Therapy Initiation with Bictegravir/Emtricitabine/Tenofovir Alafenamide in Spain

“…Regarding the HIV lifetime cost, in the absence of robust data for Spain, an HIV cost derived from a cost-effectiveness analysis was used. This cost included all health care inputs consumed and occupational losses generated during HIV disease, from the median age at diagnosis until death [32]. To analyse its impact on the results, an alternative HIV cost was tested in the OWSA, estimating the lifetime cost based on the annual healthcare cost by HIV patients in Spain obtained from a systematic review [43], and the life expectancy [44,45].…”

“…The HIV lifetime cost, including HIV-direct and -indirect costs, in Spain (€325,408) was identified in the literature [32] and was updated from 2015 to 2020 values.…”

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

“…Also performed in the Netherlands, the most recently reviewed study shows that 92% and 73% of the simulations were cost-effective, of which 52% and 23% were cost-saving (respectively, without and with risk compensation) [ 9 ]. In Catalonia, although at the time of the study PrEP was not approved in Spain nor was the generic drug available yet, some research suggested that PrEP would be cost-saving under a certain assumption on price reduction and its annual cost would range between €25.3–46.7 million/year (on demand PrEP), and €42.9–78.7 million/year (daily basis PrEP) [ 10 ].…”