Table 4.
Cost-effectiveness of pre-exposure prophylaxis (PrEP) delivery via service delivery models individually or combined.
| 40,000 starters in 2032, 85% effectiveness, 10% consistent use with 95% effectiveness | Total costs (Billions THB) | QALYs Gained compared to no PrEP (Median) |
Average cost- effectiveness ratio compared to no PrEP | Incremental cost- effectiveness ratio compared to last cost-effective intervention | Conclusion | Budget impact 2021–2025 (Millions THB) | |
|---|---|---|---|---|---|---|---|
| no PrEP (baseline) | 6.7 B | ||||||
| 1 | PrEP via government (24% of starters) | 6.8 B | 1000 | 90,600 | Cost- effective | 26 M | |
| 2 | PrEP via KPLHS (57% of starters) | 6.8 B | 2000 | 64,000 | 37,300 | Cost- effective | 30 M |
| 3 | PrEP via KPLHS + government (81% of starters) | 6.9 B | 3000 | 72,500 | 90,000 | Cost- effective | 60 M |
| 4 | PrEP via KPLHS + PrEP-15 + government (100% of starters) | 7.0 B | 4000 | 64,500 | 40,500 | Cost- effective | 68 M |
| 120,000 starters, 85% effectiveness, 10% cons use with 95% effectivenesses |
Total costs (Billions THB) |
QALYs Gained compared to no PrEP (Median) |
Average cost- effectiveness ratio |
Incremental cost- effectiveness ratio |
Conclusion |
Budget impact 2021–2025 (Millions THB) |
|
| no PrEP (baseline) | 6.7 B | ||||||
| 1 | PrEP via government (24% of starters) | 7.1 B | 4000 | 88,900 | Cost- effective | 90 M | |
| 2 | PrEP via KPLHS (57% of starters) | 7.2 B | 7000 | 62,400 | 28,000 | Cost-effective | 98 M |
| 3 | PrEP via KPLHS + government (81% of starters) | 7.5 B | 10,000 | 79,200 | 87,800 | Cost- effective | 183 M |
| 4 | PrEP via KPLHS + PrEP-15 + government (100% of starters) | 7.6 B | 12,000 | 77,000 | 65,900 | Cost- effective | 204 M |
|
120,000 starters in 2032, 85% effectiveness, 50% cons use with 95% effectiveness |
Total costs (Billions THB) |
QALYs Gained compared to no PrEP (Median) |
Average cost- effectiveness ratio | Incremental cost- effectiveness ratio | Conclusion | Budget impact 2021–2025 (Millions THB) | |
| no PrEP (baseline) | 6.7 B | ||||||
| 1 | PrEP via government (24% of starters) | 7.7 B | 10,000 | 93,400 | Cost- effective | 198 M | |
| 2 | PrEP via KPLHS (57% of starters) | 8.0 B | 19,000 | 67,600 | 37,000 | Cost- effective | 233 M |
| 3 | PrEP via KPLHS + government (81% of starters) | 8.9 B | 28,000 | 78,200 | 100,700 | Cost- effective | 424 M |
| 4 | PrEP via KPLHS + PrEP-15 + government (100% of starters) | 9.4 B | 33,500 | 78,500 | 88,200 | Cost- effective | 482 M |
In each scenario, average and incremental cost-effectiveness ratios are calculated from the total additional cost and total quality adjusted life years (QALYs) gained. The budget impact represents the undiscounted short-term costs of each intervention over 2021–2025. For non-consistent PrEP starters 85% effectiveness is assumed, while for individuals using PrEP consistently 95% effectiveness is assumed. We defined consistent use as daily PrEP use with high retention (average duration of five years) in the PrEP programs.