Abstract
Antiretroviral treatment (ART) and pre-exposure prophylaxis (PrEP) for HIV-serodiscordant couples, effectively reduce mortality, transmission events and influence quality of life at the expense of increased costs. We aimed to evaluate health economics of antiretroviral-based strategies for HIV-serodiscordant couples in the China context. A deterministic model of HIV evolution and transmission within a cohort of serodiscordant couples was parameterized using the real-world database of Zhoukou city and published literature. We evaluated the mid-ART (a historical strategy, initiating ART with CD4 < 500 cells/mm3), early-ART (the current strategy, offering ART regardless of CD4 cell counts) and a hypothetical strategy (early-ART combined short-term daily PrEP) versus the late-ART (the baseline strategy, initiating ART with CD4 < 350 cells/mm3) offered by 2008 national guidelines. We estimated the incremental cost-effectiveness ratios (ICER) and incremental cost-utility ratios (ICUR) from a societal perspective, derived by clinical benefits and HIV-caused life quality respectively, and portrayed their changes over a 0–30 year’s timeframe. The model projections indicated that the antiretroviral-based interventions were more likely to obtain clinical benefits but difficult to improve quality of life, and cumulative ICER and ICUR were generally decreasing without achieving cost-saving. Scale-up access to ART for the HIV-positive among serodiscordant couples was easily fallen within the range of paying for incremental life-years and quality adjusted life years by the societal willingness. The hypothetical strategy had the potential to prevent most seroconversion events within marriages but required enormous upfront costs, thus it took a long time to reach established thresholds. The current strategy of early-ART is the most cost-effective. Clarifying the obstacles of high cost of PrEP and improving life quality for HIV-serodiscordant couples have emerged as an urgent requisition.
Highlights
Antiretroviral treatment (ART) and pre-exposure prophylaxis (PrEP) for HIV-serodiscordant couples, effectively reduce mortality, transmission events and influence quality of life at the expense of increased costs
Over 10-year period and 30-year period, the overall life quality of the index partners was highest in the early-ART group, with corresponding quality-adjusted life year (QALYs) of 5.03 and 10.50 respectively
The QALYs gained of the mid-ART group and the early-ART group increased over time because it is compensated by the benefits of an increase of life expectancy due to the early access of ART, as compared with late-ART
Summary
Antiretroviral treatment (ART) and pre-exposure prophylaxis (PrEP) for HIV-serodiscordant couples, effectively reduce mortality, transmission events and influence quality of life at the expense of increased costs. The latest guidelines of the World Health Organization (WHO) in 2016 recommend offering antiretroviral treatment (ART) for all HIV-seropositive partners regardless of CD4 cell count and oral pre-exposure prophylaxis (PrEP) for HIV-seronegative partners at high risk of HIV s eroconversion[3]. ART scale-up for HIV-serodiscordant couples simultaneously benefits in HIV suppression for seropositive partners and prevents onward transmissions in their seronegative partners, has been demonstrated in both clinical trials and real-world s ettings[7,8,9,10,11,12,13,14,15]. The obstacles might responsible for that most countries will not meet these commitments at the appointed time[18]
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