P2-S6.11 The cost-effectiveness of screening men who have sex with men for rectal chlamydial and gonococcal infection to prevent HIV infection

Abstract Globally, in 2018 1.7 million people contracted Human Immunodeficiency Virus (HIV) and 770,000 people died from AIDS-related illnesses. Men Who Have Sex with Men (MSM) have one of the highest probabilities of HIV transmission. In Italy, in 2018 2,847 new HIV cases were diagnosed, of which 39% among MSM. The MSM population accounts for 16,690 individuals whereof 50% already underwent the Highly Active Antiretroviral Therapy (HAART). The aim of this study is to evaluate the cost-effectiveness of daily Pre-Exposure Prophylaxis (PrEP) in the Italian MSM susceptible population. A Markov transition model was calibrated to the HIV epidemic among MSM in Italy, comparing PrEP to naïve patients (NP). Model parameters were retrieved by querying scientific databases. Transition probabilities were adjusted for incidence of HIV while costs and benefits were discounted at an annual rate of 3%. The impact on results of critical parameters was explored through a Monte Carlo-based sensitivity analysis. The cost-effectiveness analysis results were reported as Incremental Cost-Effectiveness Ratio (ICER) express as € per Quality Adjusted Life Year (QALY) gained. The introduction of such a PrEP program would result in a total cost of €822,398,199 million and lead to a gain of 70,762 discounted QALYs over an 85-year time horizon. Assuming a 92% efficacy of PrEP therapy, the ICER for the PrEP program is €4,346.16/QALY gained. This value is definitively lower than acceptability NICE threshold (£20,000). PrEP can reduce the infection rate up to 60% in a five-year period. The Monte Carlo simulation confirmed the robustness of the model results. This analysis showed PrEP to be cost-effective when used in a susceptible population. Even if PrEP doesn't protect from other sex-related infectious diseases, it could prevent HIV transmission, thus breaking down HIV-infection incidence rate. Each country should reflect on the real possibility to implement a robust Public Health program pondering the adoption of PrEP. Key messages PrEP is very effective at reducing HIV infection when taken correctly. It is the backbone in the “combination prevention”, necessary to reach the SDG of ending the AIDS epidemic by 2030. This preliminary analysis suggests that the introduction of a daily PrEP program for MSM in Italy is cost-effective and possibly cost saving in the long term.

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A Prospective Evaluation of the Cost Effectiveness of Adding Lamivudine to Zidovudine-Containing Antiretroviral Treatment Regimens in HIV Infection

PharmacoEconomics ◽

10.2165/00019053-199915001-00004 ◽

1999 ◽

Vol 15 (Supplement 1) ◽

pp. 39-53 ◽

Cited By ~ 4

Author(s):

L Lacey ◽

M Youle ◽

P Trueman ◽

S Staszewski ◽

M Schrappe ◽

...

Keyword(s):

Cost Effectiveness ◽

Hiv Infection ◽

Antiretroviral Treatment ◽

Prospective Evaluation ◽

Treatment Regimens ◽

The Cost

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Systematic Review Of Studies Estimating The Cost-Effectiveness Of Hiv Pre-Exposure Prophylaxis (Prep) In Men Who Have Sex With Men (Msm)

Value in Health ◽

10.1016/j.jval.2016.09.409 ◽

2016 ◽

Vol 19 (7) ◽

pp. A417

Author(s):

O Damm ◽

S Scholz ◽

W Greiner

Keyword(s):

Systematic Review ◽

Cost Effectiveness ◽

Sex With Men ◽

Exposure Prophylaxis ◽

The Cost

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Advanced HIV Infection Treated with Zidovudine Monotherapy: Lifetime Values of Absolute Cost—Effectiveness as a Pharmacoeconomic Reference for Future Studies Evaluating Antiretroviral Combination Treatments

Annals of Pharmacotherapy ◽

10.1177/106002809703101201 ◽

1997 ◽

Vol 31 (12) ◽

pp. 1447-1454 ◽

Cited By ~ 3

Author(s):

Andrea Messori ◽

Paola Becagli ◽

Valeria Berto ◽

Sabrina Trippoli ◽

Maria Font ◽

...

Keyword(s):

Cost Effectiveness ◽

Hiv Infection ◽

Cost Utility ◽

Antiretroviral Drugs ◽

Average Lifetime ◽

Combined Method ◽

Zidovudine Monotherapy ◽

The Absolute ◽

Triple Treatment ◽

The Cost

OBJECTIVE: This study was undertaken to evaluate the cost and the effectiveness of zidovudine monotherapy in patients with advanced HIV infection and to derive preliminary data on the cost—effectiveness of the triple treatment with saquinavir plus zalcitabine plus zidovudine compared with zidovudine alone. DESIGN: We used a combined method of survival analysis utilizing both the quality-adjusted time without symptoms or toxicity (Q-TWIST) method and the Gompertz approach. This combined method was applied to assess the absolute cost-effectiveness and cost—utility ratios of zidovudine monotherapy and to perform a preliminary incremental cost—effectiveness comparison of saquinavir plus zalcitabine plus zidovudine versus zidovudine alone. The clinical material used in our study was derived from two reports on the treatment of advanced HIV infection. Data of lifetime costs of HIV infection were obtained from published information. RESULTS: In patients with advanced HIV infection treated with zidovudine monotherapy, lifetime survival was 252.1 discounted person-years per 100 patients. Using an average lifetime cost of $93 000 (discounted) per individual, the absolute ratio of cost—effectiveness for zidovudine monotherapy was $36 980 per life-year, while the absolute cost—utility ratio was $47 112 per quality-adjusted life-year. In the comparative analysis of saquinavir plus zalcitabine plus zidovudine versus zidovudine alone, our calculations showed that the administration of the triple treatment can have an “average” cost—effectiveness, provided that mean lifetime survival per patient (discounted) is improved to at least 3.68 years (with an average survival gain of at least 14 mo per patient). CONCLUSIONS: The values of absolute cost—effectiveness and cost—utility ratios for zidovudine monotherapy are a useful reference point for further pharmacoeconomic studies in the area of antiretroviral drugs.

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