暴露前预防用药预防我国男男性行为者感染HIV的经济成本效益

Cost-effectiveness analysis of pre-exposure prophylaxis for men who have sex with men in China

目的评价暴露前预防用药（PrEP）预防中国男男性行为者（MSM）感染艾滋病病毒（HIV）的经济成本效益。方法将中国MSM分为无干预策略组（简称无干预组）、标准HIV干预策略组（简称标准干预组）和每日口服PrEP联合标准HIV干预策略组（简称联合干预组）。利用马尔科夫（Markov）决策模型评价20年后三种干预策略组的医疗成本和健康效益（质量调整生命年,QALY）,并对模型进行敏感度分析。结果在实现干预20年时,无干预组、标准干预组和联合干预组在贴现后的医疗成本,分别为88 633.70元/人、86 421.59元/人和186 621.56元/人;健康效益分别为17.36QALY/人、17.53QALY/人和18.15QALY/人。相对于标准干预组,联合干预组每多获得1个QALY需要额外支付162 395.24元,大于当前人均国内生产总值（GDP）（53 980元）,不具有成本效益。敏感度分析表明,联合干预组相对标准干预组不具成本效益的结果保持稳定。若将联合干预组的当前最低成本降低5.5%,其相对于标准干预组将具有成本效益。结论相对于当前标准干预策略,每日口服PrEP联合标准HIV干预策略的成本效益较低,有必要探索降低其干预成本的使用模式。

Objective To investigate the cost-effectiveness of pre-exposure prophylaxis（PrEP）for HIV prevention among MSM in China.Methods We differentiated the MSM into three groups of the non-intervention strategy,the standard HIV intervention strategy and the daily oral administration of PrEP combined with the standard HIV intervention strategy,constructed a Markov decisive model to assess medical cost and health effectiveness（quality adjusted life years,QALY）under the three strategies after 20 years,and evaluated the model robustness by sensitivity analysis.Results After 20 years,the non-intervention strategy,the standard HIV intervention strategy and the daily oral administration of PrEP combined with the standard HIV intervention strategy costed（discounted）88633.70 yuan/person,86 421.59 yuan/person and 186 621.56 yuan/person respectively,and obtained 17.36 QALY/person,17.53 QALY/person and 18.15 QALY/person respectively.The incremental cost-effectiveness ratio of the daily oral administration of PrEP combined with the standard HIV intervention strategy to the standard HIV intervention strategy was 162 395.24 yuan/QALY, 〉53 980 yuan（the per capita GDP）/QALY.Sensitivity analysis showed that the combined intervention strategy kept consistently non-cost effective compared to the standard HIV intervention strategy.If the current minimum cost of the combined intervention strategy was reduced by 5.5%,it would be cost-effective compared to the standard intervention strategy.Conclusion As for HIV/AIDS prevention among MSM in China,compared with the current standard intervention strategy,the cost-effectiveness of the combined strategy including daily oral administration of PrEP is low,and we need to explore use patterns to reduce its cost.