Cost-Effectiveness of Using Conditional Economic Incentives to Improve Pre-exposure Prophylaxis Adherence Among Male...

Area of Science:

• Public Health
• Health Economics
• Behavioral Economics

Background:

• Conditional economic incentives show promise for improving medication adherence in populations at risk for HIV.
• Limited data exist on the cost-effectiveness of incentive programs for pre-exposure prophylaxis (PrEP) adherence among male sex workers (MSWs), a high-risk group for HIV acquisition.

Purpose of the Study:

• To assess the cost-effectiveness of incentive programs aimed at improving PrEP adherence among MSWs.

Main Methods:

• Economic evaluation of the PrEP Seguro randomized pilot trial in Mexico (NCT03674983) involving 110 MSWs.
• Intervention group received tiered incentives based on scalp hair PrEP drug levels over 6 months.
• Micro-costing from a health system perspective and Quality-Adjusted Life Years (QALYs) estimation based on averted HIV infections.

Main Results:

• The intervention group showed a 28.7% increase in PrEP concentration, indicating improved adherence (p=0.05).
• PrEP adherence increased from 62% in standard care to 78% in the incentive group over 6 months.
• The 6-month Incremental Cost-Effectiveness Ratio (ICER) was US $20.92/QALY gained, deemed highly cost-effective.

Conclusions:

• Behavioral economics approaches, like incentives, can enhance HIV prevention adherence, yielding significant health and economic advantages.
• Incentive programs for PrEP adherence among high-risk populations present a cost-effective strategy for reducing HIV incidence.
• Further implementation trials are recommended to determine the cost-effectiveness of scaling up these incentive programs.