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治疗 (作为预防) 可用性和个人的行为:卡博特格拉维尔长效注射PrEP的成本效益分析
J Felipe Montano-Campos1, Blythe Adamson2
1CHOICE Institute, School of Pharmacy, University of Washington, 1956 NE Pacific St H362, Seattle, WA, 98195, USA. fmontano@uw.edu.
PharmacoEconomics - open
|August 12, 2025
概括
对艾滋病毒的长效暴露前预防 (PrEP) 是具有成本效益的,即使有潜在的行为变化. 这种可注射的选择提供了一种对每日药片的谨慎替代方案,改善了艾滋病毒预防策略的坚持和整体价值.
科学领域:
- 公共卫生与流行病学
- 卫生经济学 卫生经济学
- 行为科学 行为科学
背景情况:
- 长效注射性暴露前预防 (PrEP) 已被FDA批准用于预防艾滋病毒.
- 这些药物提供了一种谨慎的,不太频繁的替代每日口服药物的替代品,可能会提高其坚持性和有效性.
- 行为转变,如避孕套使用和性伴侣的变化,可能是由于风险感知的改变而发生的.
研究的目的:
- 模拟内源性行为反应,以长效PrEP的可用性.
- 进行成本效益分析,比较长效PrEP (cabotegravir) 与每日口服TDF/FTC.
主要方法:
- 开发了一个进化游戏理论框架,以模拟高风险人群 (与男性发生性关系的cisgender男性,跨性别女性) 的行为反应.
- 定义了基于避孕套使用和性伴侣数量的"保护性" (P) 和"非保护性" (NP) 行为策略.
- 将这些行为群集集成到一个马尔科夫健康状态过渡模型中,其经济和健康结果的参数各不相同.
主要成果:
- 根据人口战略的成本效益有所不同:如果所有保护措施都不太可能 (US$109,769/QALY),如果所有非保护措施都具有高度成本效益 (US$54,536/QALY).
- 在均的分配 (50/50),长效PrEP具有成本效益,每QALY获得85,152美元.
- 非保护组显示出更大的QALY收益由于风险较高的行为结合PrEP高疗效,尽管保护组的增量成本更高.
结论:
- 与每日口服PrEP相比,长效PrEP是一种具有成本效益的选择.
- 这种成本效益甚至在考虑潜在的行为转向增加风险时也是如此.
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