Preexposure prophylaxis for men who have sex with men in the Netherlands: impact on HIV and Neisseria gonorrhoeae transmission and cost-effectiveness

Reitsema, M.; Hoek, A.J. van; Loeff, M.S. van der; Hoornenborg, E.; Sighem, A. van; Wallinga, J.; ... ; Xiridou, M. (2020)

Article / Letter to editor

Objectives: To assess the impact of a preexposure prophylaxis (PrEP) programme for high-risk men who have sex with men (MSM), which includes gonorrhoea testing and treatment, on the transmission of HIV and Neisseria among MSM in the Netherlands and the cost-effectiveness of such programme with and without risk compensation (in the form of reduced condom use). Methods: We developed a stochastic agent-based transmission model of HIV and gonorrhoea. We simulated a capped (max 2.5% of MSM) and uncapped (5.5% of MSM in 2018 declining to 3% in 2027) daily PrEP programme for high-risk MSM, with 3-monthly HIV and gonorrhoea testing, with and without risk compensation. Epidemiological outcomes were calculated from the transmission model and used in an economic model to calculate costs, quality-adjusted life-years (QALY), and incremental cost-effectiveness ratios (ICER), over 2018-2027, taking a healthcare payer perspective. Results: Without risk compensation, PrEP can lead to a reduction of 61 or 49% in the total number of new HIV infections in 2018-2027, if the programme is uncapped or capped to 2.5% of MSM, respectively. With risk compensation, this reduction can be 63 or 46% in the uncapped and capped programmes, respectively. In all scenarios, gonorrhoea prevalence decreased after introducing PrEP. Without risk compensation, 92% of simulations were cost-effective (of which 52% cost-saving). With risk compensation, 73% of simulations were cost-effective (of which 23% was cost-saving). Conclusion: A nationwide PrEP programme for high-risk MSM can result in substantial reductions in HIV and gonorrhoea transmission and be cost-effective, even with risk compensation.

• cost-effectiveness
• economic analysis
• gonorrhoea
• HIV
• men who have sex with men
• preexposure prophylaxis
• transmission model

• All authors: Reitsema, M.; Hoek, A.J. van; Loeff, M.S. van der; Hoornenborg, E.; Sighem, A. van; Wallinga, J.; Benthem, B. van; Xiridou, M.
• Date: 2020-03-15
• Journal: AIDS
• Volume: 34
• Issue: 4
• Pages: 621 - 630
• DOI: doi:10.1097/QAD.0000000000002469
• Link: https://journals.lww.com/aidsonline/Fulltext/2020/03150/Preexposure_prop...