预计在东部和南部非洲的长效艾滋病毒暴露前预防产品的成本门:一个数学建模研究
David Kaftan1, Monisha Sharma2, Danielle Resar3
1Department of Population Health, New York University Grossman School of Medicine, New York, New York, 10016, USA.
Journal of the International AIDS Society
|February 25, 2025
概括
负担得起的长效暴露前预防 (LA-PrEP) 对东部和南部非洲的艾滋病毒预防至关重要. 风险优先推广和降低价格是使LA-PrEP在该地区具有成本效益的关键.
科学领域:
- 公共卫生 公共卫生
- 流行病学 流行病学
- 卫生经济学 卫生经济学
背景情况:
- 东部和南部非洲 (ESA) 需要负担得起的艾滋病毒预防工具.
- 长期作用的暴露前预防 (LA-PrEP) 是有前途的,但在ESA面临医疗保健资源限制.
- 估计LA-PrEP的成本效益值对于资源有限的环境至关重要.
研究的目的:
- 确定南非,津巴布韦和肯尼亚的LA-PrEP产品的最大成本效益价格.
- 为了比较不同LA-PrEP配方 (口服,每2个月,每6个月注射) 和推广策略的成本效益.
- 模拟LA-PrEP对35年来艾滋病毒感染的影响.
主要方法:
- 一个基于代理的模型 (EMOD-HIV) 在三个ESA国家模拟了LA-PrEP的推出.
- 覆盖范围在5%-20%的艾滋病毒阴性成年人之间,优先考虑与统一的风险组向.
- 成本效益被定义为<500美元每次残疾调整后避免的生命年,比较LA-PrEP与每日口服PrEP.
主要成果:
- 风险优先的LA-PrEP (5%覆盖率) 避免了11-21%的艾滋病毒感染,成本高于非优先的部署.
- 6个月内注射LA-PrEP的每剂量最大成本因国家而异:南非 (52.99美元),津巴布韦 (14.64美元),肯尼亚 (7.50美元).
- 每月口服LA-PrEP的最大每剂费用较低:南非 (5.02美元),津巴布韦 (1.45美元),肯尼亚 (0.87美元).
结论:
- 在ESA中,LA-PrEP的成本效益对定价和推广策略敏感.
- 降低LA-PrEP定价和/或风险优先实施是成本效益的必要条件.
- 有针对性的推广策略可以在预算限制范围内最大限度地提高LA-PrEP对公共卫生的影响.
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