Is Pre-exposure prophylaxis cost-effective for HIV in the UK?

Description of the Study

The HIV incidence rate among British males who have sex with other men has remained high for several years despite the widespread use of antiretroviral medications and the high rates of virological suppression. This is true even if virological suppression rates are very high. This is true even though these males have high levels of virological suppression. Pre-exposure prophylaxis, or PrEP as it is more widely known, may or may not be beneficial in preventing the spread of new illnesses.

Study Design

The HIV Synthesis Model is a dynamic individual-based simulation model that the researchers employed for their modeling and health economic analysis. The model was modified to account for the UK’s HIV pandemic, which had already received extensive prior reporting. It was not essential to get ethical approval or authorization for this inquiry. A probabilistic sensitivity analysis was performed to get the primary findings, and 22 important components were randomly chosen as the selection criterion Is Pre-exposure prophylaxis cost-effective for HIV in the UK? We initially divided each parameter distribution into tertiles to reduce the random variability connected with the presentation of the critical results. The researchers used the same parameter tertiles combination to get the mean across simulations. This was done to ensure that the results were consistent. To arrive at an accurate estimate of the possible advantages to health, we considered all of the relevant variables that may affect the number of HIV infections that could be averted.

Identification

The HIV incidence rate among British males who have sex with other men has, for a long time, remained high despite the widespread use of antiretroviral drugs and the high rates of virological suppression. The fact that these individuals have realistic virological suppression rates does not change this reality. Pre-exposure prophylaxis, often known as PrEP, is a very efficient method of avoiding new infections; nevertheless, the question of whether or not it is also cost-effective is still up for debate.

Measurements

Comparisons were made between the two main scenarios. One assumed that PrEP was not accessible, and the other predicted that sexual event-based PrEP would become available between April and June 2016. (A representative sample of all pills taken each week was acquired; the average was five tablets.) All of these hypothetical situations were predicated on the premise that persons will continue to engage in sexual activities, get HIV testing often, and possibly begin antiretroviral medication (ART). Similar to the criteria for eligibility in the PROUD trial, assumptions regarding MSM eligibility for PrEP included a negative HIV test at the beginning of PrEP, reporting condom-free anal sexual activity in the previous three months, and having another recorded negative HIV test one year before.

Cost Valuation and Consequences

The study’s results convinced the researchers that the proportion of eligible males who participated in the PrEP program directly affected the size of the health benefit. The amount of money they might save by investigating a maximum PrEP program that could treat 27,000 males at its peak depends on the program’s size and the risk of HIV infection among PrEP participants. In other words, the amount of money they could save depends on both factors. When the PrEP program is first made available to the general public, the number of men who take advantage of the opportunity to enroll in the program will be one factor that determines how broad the program will be. Unfortunately, evaluating this metric accurately under any conditions in the current situation is impossible. The introduction of PrEP has a more significant influence on reducing HIV infections within the scope of a broader PrEP program and is more cost-effective than the baseline scenario. This is because more guys who report participating in sexual activity without using condoms and who recently had an HIV test that was negative are now seeking pre-exposure prophylaxis.

Discounting

There is a discount in the process of economic evaluation. In the process of cost analysis carried out in this study, there is a decrease in cost. A program like this would save total expenses by one billion dollars over 80 years and prevent twenty-five percent of new HIV infections, of which forty-two percent would be directly due to the PrEP program. In addition to that, 40,000 QALYs would be obtained after discounting them.

Incremental Analysis

The researchers considered the incremental cost in their analysis. The researchers evaluated the many factors that go into estimating the number of HIV infections that may be avoided to estimate the health benefit. To calculate the additional cost, the researchers considered the interaction of all 22 factors tested in the probabilistic sensitivity analysis. They could get an estimate of the incremental cost due to this. Fixing the parameters arbitrarily picked in the probabilistic sensitivity analysis made it feasible to do univariate sensitivity studies, which was impossible before.

Results Presentation

Adopting such a PrEP program reduced overall expenditures by £1 billion after discounting them, prevented 25% of new HIV infections, of which 42% would be due directly to PrEP, and increased discounted QALYs by 40.000 over 80 years. The prevention of new HIV infections caused forty-two percent of those illnesses linked to PrEP. These benefits may all be connected to preventing or decreasing HIV transmission. Over an unforeseen period, the process by which these advantages would become evident would occur. Pre-exposure prophylaxis, or PrEP, medication should be begun as soon as practical to get the best outcomes.

 Discussion of Results

According to the study results, implementing a PrEP program for MSM in the UK would seem to be both cost-effective and potentially save money over the long run. If the price of antiretroviral drugs, particularly those used for pre-exposure prophylaxis (PrEP), were to decline, it would take a substantially shorter amount of time to witness reductions in treatment costs. This would result in significant cost reductions realized much more quickly. Setting aside a much smaller percentage of the total amount of money would be necessary. Using event-based PrEP with the proposed eligibility criteria results in significant cost savings. The outcomes of the modeling study and economic analysis conducted by the researchers indicate that it has positive effects on health owing to a substantial reduction in the incidence of HIV. This conclusion was arrived at after considering the study’s findings. This was the conclusion reached based on the study results, which the researchers used as the foundation for their decisions. According to the researchers’ results, this is a valid point of view to consider.

Despite significant deviations from the critical hypothesis, the researchers looked at their conclusions and realized they were still valid. Our fundamental findings suggest that there will be an increase in overall spending for the first twenty years before the incremental cost-effectiveness ratio falls below 13 000 pounds sterling for each additional year of quality-adjusted life obtained. When a sufficiently long-time horizon is considered, the adoption of PrEP does result in cost savings; nonetheless, their main results indicate that there will be an increase in overall costs within the first 20 years of implementation. An essential element in assessing the cost impact of such a program is the proportion of the population eligible for pre-exposure prophylaxis (PrEP) who use it. This proportion determines the scope of the PrEP program. This is due to the proportionate relationship between the population’s eligibility for PrEP and the number of persons who use it. This is because the total number of individuals who qualify for PrEP is proportional to the number of people who use the medication.

The researchers’ analysis was based on the assumption that, even in the most probable scenario, the rate of HIV testing would not change. This was the first situation they encountered. This was done since it is standard procedure in health economics to proceed with the presumption that the current status would not change. The researchers were able to accomplish our goals directly from the circumstances described above. Despite this, there has been a noticeable rise in the number of people tested in the UK in recent years, notably at specific clinics. This rise has co-occurred as medication has been more readily available after a diagnosis and, to a lesser degree, the ability to buy PrEP over the internet. The number of persons being tested has increased due to the various variables contributing to this trend.

All of these factors have contributed to the recent rise in the number of tested people. This has led to a drop in patients visiting these clinics who have just received a diagnosis. This is the direct outcome of what has taken place. They thought the coordinated actions were to blame for the reported decline in the number of new diagnoses seen. As a consequence of more excellent testing and the commencement of ART upon diagnosis, our HIV Synthesis Model projected that there would be a drop in the incidence of HIV as the percentage of persons living with HIV who are on ART rose. As a result, fewer new HIV cases would be detected overall. This resulted from further testing and starting ART therapy earlier in the diagnostic process.

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