Evaluating the cost-effectiveness of a pre-exposure prophylaxis program for HIV prevention for men who have sex with men in Japan

Nao Yamamoto,Misao Takano,Shingo Iwami,Shinichi Oka,Yoshiki Koizumi,Daisuke Mizushima,Shinya Tsuzuki,Keisuke Ejima

doi:10.1038/s41598-022-07116-4

Abstract

Men who have sex with men (MSM) have been disproportionally affected by the HIV epidemic in many countries, including Japan. Although pre-exposure prophylaxis (PrEP) is a strong prevention tool, it is not yet approved in Japan. A Markov model was developed to describe HIV infection and disease progression in an MSM cohort (N = 1000) in Japan receiving a PrEP program. The model was used to evaluate the cost-effectiveness of a PrEP program. HIV/AIDS treatment, screening, hospitalization due to AIDS, and PrEP were considered as costs and quality-adjusted life-years (QALYs) gained as utilities. Cost-effectiveness was assessed by comparing the incremental cost-effectiveness ratio (ICER) over a 30-year period against the willingness to pay (WTP) threshold. One-way sensitivity and probabilistic sensitivity analyses were performed. With 50% PrEP coverage, the PrEP program became dominant against the program without PrEP, using a threshold of 5.0 million JPY/QALY (45,455 USD). The probabilistic sensitivity analysis revealed that the PrEP program was dominant or at least cost-effective in most cases of 10,000 simulations. Therefore, preparing cheaper PrEP pills, which results in PrEP being dominant or ICER being lower than the WTP threshold, is important to make the program cost-effective. Introduction of PrEP to an MSM cohort in Japan would be cost-effective over a 30-year time horizon.

Highlights

HIV/AIDS is not yet a curable disease
Our results showed that the pre-exposure prophylaxis (PrEP) program would be cost-saving, even in an Men who have sex with men (MSM) cohort in Japan with a relatively low risk for HIV infection
We used a Markov model to describe HIV infection and disease progression to evaluate the cost-effectiveness of a PrEP program for MSM in Japan

Summary

Introduction

The expected lifespan of those living with HIV infection and receiving antiretroviral therapy (ART) in high-income countries, especially with early initiation of treatment, is comparable with that among people without H IV1,2. ART is considered both a treatment tool for those living with HIV and a prevention tool (i.e., “treatment as prevention”). A potential barrier to PrEP approval in Japan may be that the PrEP program is not considered cost-effective because the incidence and prevalence of HIV are lower than in other high-income countries (i.e., the cost of the PrEP program exceeds the benefit gained by the program). The present study aimed to assess the cost-effectiveness of introducing a PrEP program to a cohort of MSM in Tokyo, Japan, where the risk for HIV infection is relatively low. We assessed the costeffectiveness of the PrEP program by comparing the cost of treatment and the PrEP program versus the utilities gained by the program

Methods

Results

Conclusion