Economic Evaluation Of PrEP Prevention Strategy In MSM Population

Objective: The global AIDS epidemic situation is severe,a large number of HIV/AIDS prevention and control measures have been studied in the world,in which the biomedical prevention of HIV / AIDS pre-exposure prophylaxis has become a research hotspot.And it has been proved to be effective and safe by many foreign studies.Therefore,in recent years,the World Health Organization(WHO)has promoted PrEP strategy as part of the comprehensive AIDS prevention and control measures.In China,prophylaxis of drug use before AIDS exposure has been proved to be effective,but it is only at the stage of theory and scientific research and has not been popularized in practice.Suppose that through the marketing of tenofovir TDF into pharmacies(purchased by doctor's prescription),we can popularize the PrEP in the population of MSM in the whole country,and evaluate the PrEP strategy by health economics in this study.It provides a reference for the promotion of PrEP strategy.Methods: Based on the data collected by the research group and the literature retrieval data,the number of new HIV infections that could beavoided under different compliance with PrEP strategy in MSM population in China was predicted under the hypothetical conditions.On the one hand,the cost(including drug cost,transportation cost,mis-work cost,cost-effect analysis)is calculated by self-defined formula.On the other hand,Markov model is used to simulate the number of newly infected HIV patients under no adopting PrEP strategy.To calculate the economic burden of disease and quality adjusted life year,cost-utility analysis.Results:(1)If the PrEP measures were tested and popularized in 10 million MSM population in China for one year,340000 new HIV infections could be prevented when the compliance was moderate,and 507000 new HIV infections could be avoided when the drug compliance was high.(2)The cost of PrEP was 55.391 billion yuan when the drug compliance was medium,and 65.086 billion yuan when the drug compliance was high.(3)If the PrEP measures were not popularized,the newly infected HIV patients,who could be avoided within one year,would become HIV/AIDS patients.The cohort of this population would be simulated by the Markov model,and the cycle would be 1 year,and observed for 30 years.In each case of HIV infection,11.8606 quality-adjusted life years can be obtained,the cost of disease burden is 280840 yuan / person,and the cost-utility ratio is 23700 yuan / QALY.(4)By popularizing the intervention measures of PrEP,When PrEPcompliance was medium,the cost of a new infection of HIV avoided was7797.98 yuan for each case.In the whole life cycle,the cost of avoiding one case of HIV infection could be saved 0.1179 million yuan.8.03 QALY/ can be saved by implementing PrEP,one QALY saved by PrEP intervention strategy can save 14700 yuan at the same time.(5)When the compliance of PrEP was high,the cost of every new HIV infection avoided was 6144.56 yuan.In the whole life cycle,the cost of avoiding one case of HIV infection could be saved 0.1525 million yuan.8.03 QALY/ can be saved by implementing PrEP.The PrEP intervention strategy can save 19000 yuan for every QALY saved.(6)When the compliance of preventive drug use before exposure is low,the PrEP strategy has no protective effect,and when the compliance is moderate or high,the implementation of PrEP strategy can avoid a certain number of new HIV infections.Compared with those with high compliance and moderate compliance in MSM,the high compliance group could avoid167000 new infections and the cost per case of HIV infection could be reduced by 1653.42 yuan per person.Cost savings increased by 34.6thousand yuan per case of HIV infection avoidance throughout the life cycle.More than 4.3 thousand yuan for saving one QALY could be saved.Conclusion:(1)The higher the compliance of MSM population,the more health output and economic benefit can be obtained by implementing PrEP strategy.(2)When the compliance of MSM population is not lowerthan 80,the implementation of PrEP has great economic value.The PrEP strategy is worth carrying out.(3)The social and economic impact of AIDS is far-reaching and it is necessary to increase prevention and control.(4)The PrEP preventive measures popularized in this paper do not exist independently,but are increased on the basis of all the current comprehensive HIV prevention and control strategies,and there is a need for good compliance in MSM population.This will put higher demands on staff's publicity and education style and follow-up management model.(5)This paper focuses on the lowest present value estimate of the cost of primary HIV infection caused by the failure to implement PrEP.In fact,the economic loss caused by HIV/AIDS patients will be much higher than the estimated cost in this paper.