Modelling the Epidemiological Impact and Cost-Effectiveness of PrEP for HIV Transmission in MSM in China

Lei Zhang, Peng Peng, Yumeng Wu, Xiaomeng Ma, Nyi Nyi Soe, Xiaojie Huang, Hao Wu, Martin Markowitz, Kathrine Meyers

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Abstract

Risk of HIV infection is high in Chinese MSM, with an annual HIV incidence ranging from 3.41 to 13.7/100 person-years. Tenofovir-based PrEP is effective in preventing HIV transmission in MSM. This study evaluates the epidemiological impact and cost-effectiveness of implementing PrEP in Chinese MSM over the next two decades. A compartmental model for HIV was used to forecast the impact of PrEP on number of infections, deaths, and disability-adjusted life years (DALY) averted. We also provide an estimate of the incremental cost-effectiveness ratio (ICER) and the cost per DALY averted of the intervention. Without PrEP, there will be 1.1–3.0 million new infections and 0.7–2.3 million HIV-related deaths in the next two decades. Moderate PrEP coverage (50%) would prevent 0.17–0.32 million new HIV infections. At Truvada’s current price in China, daily oral PrEP costs $46,813–52,008 per DALY averted and is not cost-effective; on-demand Truvada reduces ICER to $25,057–27,838 per DALY averted, marginally cost-effective; daily generic tenofovir-based regimens further reduce ICER to $3675–8963, wholly cost-effective. The cost of daily oral Truvada PrEP regimen would need to be reduced by half to achieve cost-effectiveness and realize the public health good of preventing hundreds of thousands of HIV infections among MSM in China.

Original languageEnglish
Pages (from-to)523-533
Number of pages11
JournalAIDS and Behavior
Volume23
Issue number2
DOIs
Publication statusPublished - 15 Feb 2019

Keywords

  • China
  • Cost-effectiveness
  • Mathematical modeling
  • MSM
  • PrEP

Cite this

Zhang, L., Peng, P., Wu, Y., Ma, X., Soe, N. N., Huang, X., Wu, H., Markowitz, M., & Meyers, K. (2019). Modelling the Epidemiological Impact and Cost-Effectiveness of PrEP for HIV Transmission in MSM in China. AIDS and Behavior, 23(2), 523-533. https://doi.org/10.1007/s10461-018-2205-3