Table 1.
Benefits, costs and savings in healthcare costs of the individual and combined interventions, 2018~2037
| Total infection over 20 years (2018~2037), million | HIV infections prevented over 20 years, million | HIV infections prevented over 20 years, % | HIV prevalence at 2037, % | HIV incidence rate at 2037, per 100 person-years | Incremental costs, Int.$ (billion) | Incremental QALYs, million | Average CER, Int.$/QALY, relative to base case | Saving in healthcare cost, Int.$ (billion) | |
|---|---|---|---|---|---|---|---|---|---|
| Base case | 0.78 (0.60–1.00) | – | – | 11.2 (9.1–14.2) | 0.73 (0.56–0.98) | – | – | – | – |
| Test and treat (90–90) | 0.33 (0.28–0.39) | 0.45 (0.28–0.62) | 57.9% (46.4–66.5%) | 5.8 (4.8–6.8) | 0.24 (0.18–0.29) | 2.13 (0.61–4.03) | 1.22 (0.94–1.53) | 1754 (462–3960) | 8.86 (5.33–13.92) |
| PrEP-25% HRMSM | 0.68 (0.57–0.87) | 0.09 (0.06–0.14) | 12.1% (8.7–16.7%) | 9.8 (8.2–12.8) | 0.61 (0.50–0.80) | 3.08 (1.76–5.30) | 0.18 (0.12–0.23) | 17,277 (12,127–23,711) | 1.73 (0.94–2.79) |
| PrEP-50% HRMSM | 0.62 (0.52–0.80) | 0.16 (0.10–0.23) | 20.2% (15.1–26.9%) | 8.9 (7.5–11.7) | 0.53 (0.44–0.70) | 5.34 (3.07–9.10) | 0.30 (0.21–0.38) | 17,979 (12,631–24,991) | 2.87 (1.60–4.52) |
| PrEP-75% HRMSM | 0.57 (0.49–0.75) | 0.20 (0.13–0.29) | 25.7% (19.6–33.3%) | 8.4 (7.0–11.0) | 0.47 (0.40–0.63) | 6.98 (4.05–11.80) | 0.38 (0.27–0.48) | 18,452 (12,972–25,846) | 3.64 (2.06–5.64) |
| Test+PrEP-25% HRMSM | 0.53 (0.46–0.68) | 0.24 (0.15–0.34) | 30.8% (23.9–39.3%) | 7.9 (6.8–10.2) | 0.42 (0.36–0.53) | 6.83 (4.39–10.62) | 0.49 (0.37–0.61) | 13,835 (9600–18,598) | 4.36 (2.46–6.82) |
| Test+PrEP-50% HRMSM | 0.46 (0.39–0.59) | 0.32 (0.21–0.44) | 41.0% (33.3–49.9%) | 6.8 (5.8–8.8) | 0.31 (0.26–0.40) | 10.61 (6.65–16.76) | 0.64 (0.48–0.78) | 16,636 (11,595–22,919) | 5.77 (3.37–8.86) |
| Test+PrEP-75% HRMSM | 0.41 (0.35–0.53) | 0.36 (0.25–0.49) | 47.0% (39.3–55.6%) | 6.2 (5.2–8.1) | 0.25 (0.20–0.33) | 13.20 (8.25–20.85) | 0.73 (0.56–0.88) | 18,110 (12,660–25,289) | 6.64 (3.95–10.12) |
| Test and treat (90–90) + PrEP 25% HRMSM | 0.24 (0.21–0.30) | 0.53 (0.39–0.68) | 68.3% (61.1–75.4%) | 4.6 (3.7–5.6) | 0.12 (0.08–0.15) | 10.11 (7.42–13.49) | 1.33 (1.12–1.69) | 7574 (5166–10,243) | 10.17 (6.30–16.33) |
| Test and treat (90–90) + PrEP 50% HRMSM | 0.21 (0.18–0.26) | 0.56 (0.43–0.72) | 72.8% (66.6–78.7%) | 4.1 (3.4–5.1) | 0.09 (0.06–0.11) | 14.69 (10.27–20.60) | 1.40 (1.19–1.76) | 10,485 (7199–14,484) | 10.83 (6.82–17.25) |
| Test and treat (90–90) + PrEP 75% HRMSM | 0.19 (0.16–0.24) | 0.58 (0.45–0.74) | 75.2% (69.7–80.5%) | 3.9 (3.2–4.8) | 0.07 (0.05–0.09) | 17.63 (12.14–25.06) | 1.44 (1.23–1.81) | 12,218 (8415–16,992) | 11.23 (7.13–17.81) |
PrEP pre-exposure prophylaxis, QALY quality-adjusted life years, CER cost-effectiveness ratio, Int.$ international dollars, HRMSM, high-risk MSM
aInterventions that cost less than per capita gross domestic product (i.e., 15,943 Int.$) per QALYgained are defined as very cost effective [40]
bInterventions that cost between one and three times per capita gross domestic product per QALY gained are defined as cost effective [40]