Pre-exposure prophylaxis cost-effective in MSM in the long run

Introducing HIV pre-exposure prophylaxis (PrEP) to men who have sex with men (MSM) in Japan promises to be a cost-effective public health intervention in the long term, a recent study has found.

Using a Markov model, researchers looked at the HIV infection and disease progression rates in an MSM cohort in Japan (n=1,000) after the implementation of a PrEP programme. Outcomes included cost-effectiveness measures, such as quality-adjusted life years (QALYs) and the incremental cost-effectiveness ratio (ICER) over a 30-year period.

In the base scenario without the PrEP programme, the number of MSM living with HIV after 30 years was 664. At 30-percent PrEP coverage, this number dropped to 472. Increasing coverage to 50 percent and 70 percent further reduced the number of MSM living with HIV to 344 and 215, respectively. At 100 percent coverage, only 24 MSM would be living with HIV after 30 years.

At 50 percent coverage, the PrEP programme proved to be cost-effective and dominated over the no-programme scenario, with an ICER of USD 39,090.9 per QALY gained after 15 years, lower than the willingness-to-pay threshold of USD 45,454.5 per QALY gained.

“The introduction of a PrEP programme for an MSM cohort in Japan is cost-saving, at least in the long term. Cost-effectiveness assessment should be updated to reflect the cost of PrEP pills, which substantially impact the cost-effectiveness,” the researchers said.

“A challenge for further research is to estimate actual QALYs of Japanese patients with HIV with empirical data to make the results more reliable,” they added.