全球艾滋病毒发病率分析以及使用长效卡博特格拉维尔对负担能力的影响与持续和事件驱动的口服预暴露预防
1School of Medicine, Imperial College London, London, UK.
概括
长效卡博特格拉维尔 (CAB-LA) 显示高效,但价格昂贵. 在有限的全球预防预算范围内,低成本的事件驱动的tenofovir disoproxil fumarate/emtricitabine (TDF/FTC) 能够预防大多数艾滋病毒感染.
科学领域:
- 公共卫生 公共卫生
- 预防传染病 预防传染病
- 卫生经济学 卫生经济学
背景情况:
- 长效卡博特格拉维尔 (CAB-LA) 在艾滋病毒预防试验中表现出比口服天诺福维尔双素 fumarate/emtricitabine (TDF/FTC) 更高的疗效 (高达88%).
- 由于CAB-LA的高成本,在全球艾滋病毒预防预算有限的情况下,限制了其可访问性.
- 口服TDF/FTC是一种具有成本效益的通用选择,以事件驱动的疗法显示与持续使用相比的有效性.
研究的目的:
- 在固定预算限制范围内,评估不同人类免疫缺陷病毒 (HIV) 预防策略的成本效益.
- 为了比较通过连续CAB-LA,连续TDF/FTC和事件驱动的TDF/FTC预防的艾滋病毒感染人数.
主要方法:
- 进行了全球艾滋病毒发病率研究的系统审查.
- 针对五种预防策略计算了艾滋病毒感染率,包括测试,教育和服务成本 (18美元/人/年).
- 假设连续CAB-LA的有效率为90%,连续TDF/FTC为60%,事件驱动的TDF/FTC为60%,应用于10万个目标人群.
主要成果:
- 分析了涉及超过520万个人的98项研究,艾滋病毒发病率在不同人群中存在很大差异.
- 以当前价格计算,连续CAB-LA每次预防艾滋病毒感染的费用为949,487美元.
- 事件驱动的TDF/FTC是最具成本效益的,每次预防HIV感染的成本为1,923美元,其次是连续的TDF/FTC (4,231美元) 和目标价格的CAB-LA (11,453美元).
结论:
- 高价的CAB-LA显著限制了可以在固定的HIV预防预算内接受治疗的个体数量.
- 低成本,事件驱动的TDF/FTC是预防在预算限制下最大数量的艾滋病毒感染的最有效策略.
- 优化艾滋病毒预防需要平衡有效性与经济可行性,有利于为广泛的人口覆盖提供具有成本效益的仿制药选择.
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