P543 Cost-effectiveness of pre-exposure prophylaxis in MSM with event-driven and daily regimens. (14th July 2019)

• Record Type: Journal Article
• Authors: Reitsema, Maarten; Hoek, Albert Jan Van; Xiridou, Maria; Wallinga, Jacco; Benthem, Birgit Van; Sighem, Ard Van; Loeff, Maarten Schim Van Der; Prins, Maria; Hoornenborg, Elske
• Is Part Of: Sexually transmitted infections. Volume 95(2019)Supplement 1
• Page Start: A245
• Page End: A245
• Publication Date: 2019-07-14
• Subjects: gay bisexual and other men who have sex with men -- ART -- PrEP -- cost-effectiveness; Sexually transmitted diseases -- Periodicals; HIV infections -- Periodicals; 616.951005
• DOI: 10.1136/sextrans-2019-sti.618
• Languages: English
• ISSNs: 1368-4973

Abstract

Abstract : 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.