Abstract
BackgroundPre-exposure prophylaxis (PrEP) is a highly effective HIV prevention strategy for men-who-have-sex-with-men (MSM). The high cost of PrEP has until recently been a primary barrier to its use. In 2017, generic PrEP became available, reducing the costs by 90%.AimOur objective was to assess cost-effectiveness and costs of introducing PrEP in Germany.MethodsWe calibrated a deterministic mathematical model to the human immunodeficiency virus (HIV) epidemic among MSM in Germany. PrEP was targeted to 30% of high-risk MSM. It was assumed that PrEP reduces the risk of HIV infection by 85%. Costs were calculated from a healthcare payer perspective using a 40-year time horizon starting in 2018.ResultsPrEP can avert 21,000 infections (interquartile range (IQR): 16,000–27,000) in the short run (after 2 years scale-up and 10 years full implementation). HIV care is predicted to cost EUR 36.2 billion (IQR: 32.4–40.4 billion) over the coming 40 years. PrEP can increase costs by at most EUR 150 million within the first decade after introduction. Ten years after introduction, PrEP can become cost-saving, accumulating to savings of HIV-related costs of EUR 5.1 billion (IQR: 3.5–6.9 billion) after 40 years. In a sensitivity analysis, PrEP remained cost-saving even at a 70% price reduction of antiretroviral drug treatment and a lower effectiveness of PrEP.ConclusionIntroduction of PrEP in Germany is predicted to result in substantial health benefits because of reductions in HIV infections. Short-term financial investments in providing PrEP will result in substantial cost-savings in the long term.
Highlights
Sex between men is the predominant route of transmission of human immunodeficiency virus (HIV) in Europe [1]
At 85% effectiveness and 3% yearly quality-adjusted life years (QALY) discounting, the introduction of Pre-exposure prophylaxis (PrEP) was predicted to result in a median gain of 200,000 QALY (IQR: 150,000–270,000) over 40 years
Because the one-way sensitivity analysis showed that a reduction in the future costs of antiretroviral drugs would have a profound impact on the budget effect of PrEP, we further explored the short-term economic costs and the break-even point in a two-way sensitivity analysis in which we ranged the costs of antiretroviral drugs and the effectiveness of PrEP (Figures 4 and 5)
Summary
Sex between men is the predominant route of transmission of human immunodeficiency virus (HIV) in Europe [1]. The large number of new diagnoses indicates that additional HIV prevention approaches are needed One such prevention method, pre-exposure prophylaxis (PrEP) with the antiretroviral drugs tenofovir disoproxil fumarate (TDF) and emtricitabine, has been shown to prevent new HIV infections in MSM at high risk of infection [3,4,5]. Pre-exposure prophylaxis (PrEP) is a highly effective HIV prevention strategy for men-whohave-sex-with-men (MSM). PrEP can become cost-saving, accumulating to savings of HIVrelated costs of EUR 5.1 billion (IQR: 3.5–6.9 billion) after 40 years. Conclusion: Introduction of PrEP in Germany is predicted to result in substantial health benefits because of reductions in HIV infections. Short-term financial investments in providing PrEP will result in substantial cost-savings in the long term
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