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Cost-effectiveness and budget effect of pre-exposure prophylaxis for HIV-1 prevention in Germany from 2018 to 2058
- David A M C van de Vijver1 , Ann-Kathrin Richter2 , Charles A B Boucher1 , Barbara Gunsenheimer-Bartmeyer3 , Christian Kollan3 , Brooke E Nichols1,4,5 , Christoph D Spinner6,7 , Jürgen Wasem2 , Knud Schewe7 , Anja Neumann2
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View Affiliations Hide AffiliationsAffiliations: 1 Viroscience department, Erasmus Medical Centre, Rotterdam, The Netherlands 2 Institute for Health Care Management and Research, University of Duisburg-Essen, Essen, Germany 3 Department for Infectious Disease epidemiology, Robert Koch Institute, Berlin, Germany 4 Department of Global Health, Boston University, Boston, United States 5 Health Economics and Epidemiology Research Office, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa 6 Department of Medicine II, University Hospital Klinikum rechts der Isar, Munich, Germany 7 dagnä (Deutsche Arbeitsgemeinschaft niedergelassener Ärzte in der Versorgung HIV-Infizierter), Berlin, GermanyDavid van de Vijverd.vandevijver erasmusmc.nl
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Citation style for this article: van de Vijver David A M C, Richter Ann-Kathrin, Boucher Charles A B, Gunsenheimer-Bartmeyer Barbara, Kollan Christian, Nichols Brooke E, Spinner Christoph D, Wasem Jürgen, Schewe Knud, Neumann Anja. Cost-effectiveness and budget effect of pre-exposure prophylaxis for HIV-1 prevention in Germany from 2018 to 2058. Euro Surveill. 2019;24(7):pii=1800398. https://doi.org/10.2807/1560-7917.ES.2019.24.7.1800398 Received: 19 Jul 2018; Accepted: 28 Jan 2019
Abstract
Pre-exposure prophylaxis (PrEP) is a highly effective HIV prevention strategy for men-who-have-sex-with-men (MSM). The high cost of PrEP has until recently been a primary barrier to its use. In 2017, generic PrEP became available, reducing the costs by 90%.
Our objective was to assess cost-effectiveness and costs of introducing PrEP in Germany.
We calibrated a deterministic mathematical model to the human immunodeficiency virus (HIV) epidemic among MSM in Germany. PrEP was targeted to 30% of high-risk MSM. It was assumed that PrEP reduces the risk of HIV infection by 85%. Costs were calculated from a healthcare payer perspective using a 40-year time horizon starting in 2018.
PrEP can avert 21,000 infections (interquartile range (IQR): 16,000–27,000) in the short run (after 2 years scale-up and 10 years full implementation). HIV care is predicted to cost EUR 36.2 billion (IQR: 32.4–40.4 billion) over the coming 40 years. PrEP can increase costs by at most EUR 150 million within the first decade after introduction. Ten years after introduction, PrEP can become cost-saving, accumulating to savings of HIV-related costs of EUR 5.1 billion (IQR: 3.5–6.9 billion) after 40 years. In a sensitivity analysis, PrEP remained cost-saving even at a 70% price reduction of antiretroviral drug treatment and a lower effectiveness of PrEP.
Introduction of PrEP in Germany is predicted to result in substantial health benefits because of reductions in HIV infections. Short-term financial investments in providing PrEP will result in substantial cost-savings in the long term.

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References
-
European Centre for Disease Prevention and Control (ECDC), World Health Organization Regional Office for Europe. HIV/AIDS surveillance in Europe 2017 - 2016 data. Stockholm: ECDC; 2017. Available from: https://ecdc.europa.eu/sites/portal/files/documents/20171127-Annual_HIV_Report_Cover%2BInner.pdf
-
Robert Koch Institut. Schätzung der Zahl der HIV-Neuinfektionen und der Gesamtzahl von Menschen mit HIV in Deutschland. Stand Ende 2016. [Estimation of the number of new HIV infections and of the total number of people living with HIV in Germany. Data until end of 2016]. Epidemiologisches Bulletin. 2016;47:531-45. German. https://doi.org/10.1056/NEJMoa1011205
-
Grant RM, Lama JR, Anderson PL, McMahan V, Liu AY, Vargas L, et al. Preexposure chemoprophylaxis for HIV prevention in men who have sex with men. N Engl J Med. 2010;363(27):2587-99. https://doi.org/10.1056/NEJMoa1011205 PMID: 21091279
-
McCormack S, Dunn DT, Desai M, Dolling DI, Gafos M, Gilson R, et al. Pre-exposure prophylaxis to prevent the acquisition of HIV-1 infection (PROUD): effectiveness results from the pilot phase of a pragmatic open-label randomised trial. Lancet. 2016;387(10013):53-60. https://doi.org/10.1016/S0140-6736(15)00056-2 PMID: 26364263
-
Molina JM, Capitant C, Spire B, Pialoux G, Cotte L, Charreau I, et al. On-demand preexposure prophylaxis in men at high risk for HIV-1 infection. N Engl J Med. 2015;373(23):2237-46. https://doi.org/10.1056/NEJMoa1506273 PMID: 26624850
-
Marcus JL, Hurley LB, Nguyen DP, Silverberg MJ, Volk JE. Redefining human immunodeficiency virus (HIV) preexposure prophylaxis failures. Clin Infect Dis. 2017;65(10):1768-9. https://doi.org/10.1093/cid/cix593 PMID: 29020235
-
Spinner CD, Hanhoff N, Krznaric I, Knecht G, Kuemmerle T, Ruesenberg R, et al. 2016 PREP attitudes in Germany: high awareness and acceptance in MSM at risk of HIV. Infection. 2018;46(3):405-8. https://doi.org/10.1007/s15010-018-1127-3 PMID: 29478091
-
WEBAPO InfoSystem.Fürth:LAUER-FISCHER GmbH. [Accessed :19 Jul 2017]. Available from: https://www.cgm.com/lauer-fischer/loesungen_lf/lauer_taxe_lf/webapo_infosystem_lf/webapo_infosystem.de.jsp
-
Nichols BE, Boucher CAB, van der Valk M, Rijnders BJA, van de Vijver DAMC. Cost-effectiveness analysis of pre-exposure prophylaxis for HIV-1 prevention in the Netherlands: a mathematical modelling study. Lancet Infect Dis. 2016;16(12):1423-9. https://doi.org/10.1016/S1473-3099(16)30311-5 PMID: 27665989
-
van Sighem A, Boender S, Wit F, Smit C, Master A, Reiss P. HIV monitoring report 2017. Human immunodeficiency virus (HIV) infection in the Netherlands. Amsterdam: Stichting HIV Monitoring; 2017. Available from: https://www.hiv-monitoring.nl/application/files/2015/3312/7799/2017_HIV_Monitoring_Report_updated_version.pdf
-
Robert Koch Institut. Schätzung der Prävalenz und Inzidenz von HIV-Infektionen in Deutschland. Stand Ende 2014. [Estimation of the prevalence and incidence of HIV infections in Germany. Data from end 2014]. Epidemiologisches Bulletin. 2015;45:475-90. German.
-
Lodi S, Phillips A, Touloumi G, Geskus R, Meyer L, Thiébaut R, et al. Time from human immunodeficiency virus seroconversion to reaching CD4+ cell count thresholds <200, <350, and <500 Cells/mm3: assessment of need following changes in treatment guidelines. Clin Infect Dis. 2011;53(8):817-25. https://doi.org/10.1093/cid/cir494 PMID: 21921225
-
Sood N, Wagner Z, Jaycocks A, Drabo E, Vardavas R. Test-and-treat in Los Angeles: a mathematical model of the effects of test-and-treat for the population of men who have sex with men in Los Angeles County. Clin Infect Dis. 2013;56(12):1789-96. https://doi.org/10.1093/cid/cit158 PMID: 23487387
-
Cohen MS, Chen YQ, McCauley M, Gamble T, Hosseinipour MC, Kumarasamy N, et al. Antiretroviral Therapy for the Prevention of HIV-1 Transmission. N Engl J Med. 2016;375(9):830-9. https://doi.org/10.1056/NEJMoa1600693 PMID: 27424812
-
Cohen MS, Chen YQ, McCauley M, Gamble T, Hosseinipour MC, Kumarasamy N, et al. Prevention of HIV-1 infection with early antiretroviral therapy. N Engl J Med. 2011;365(6):493-505. https://doi.org/10.1056/NEJMoa1105243 PMID: 21767103
-
Donnell D, Baeten JM, Kiarie J, Thomas KK, Stevens W, Cohen CR, et al. Heterosexual HIV-1 transmission after initiation of antiretroviral therapy: a prospective cohort analysis. Lancet. 2010;375(9731):2092-8. https://doi.org/10.1016/S0140-6736(10)60705-2 PMID: 20537376
-
Marcus U, Hickson F, Weatherburn P, Schmidt AJEMIS Network. Estimating the size of the MSM populations for 38 European countries by calculating the survey-surveillance discrepancies (SSD) between self-reported new HIV diagnoses from the European MSM internet survey (EMIS) and surveillance-reported HIV diagnoses among MSM in 2009. BMC Public Health. 2013;13(1):919. https://doi.org/10.1186/1471-2458-13-919 PMID: 24088198
-
Deutsche AIDS-Gesellschaft (DAIG). Österreichische AIDS-Gesellschaft. Deutsch-Österreichische Leitlinien zur antiretroviralen Therapie der HIV-Infektion. [German-Austrian guidelines on the antiretroviral therapy of HIV infection]. Version 7. DAIG; 2017. German. Available from: https://daignet.de/site-content/hiv-therapie/leitlinien-1/deutsch-oesterreichische-leitlinien-zur-antiretroviralen-therapie-der-hiv-1-infektion
-
Drummond MF, Sculpher MJ, Claxton K, Stoddart GL, Torrance GW. Methods for the economic evaluation of health care programmes. 4th edition. Oxford: Oxford University Press; 2015. ISBN: 9780199665884
-
Mostardt S, Hanhoff N, Wasem J, Goetzenich A, Schewe K, Wolf E, et al. Cost of HIV and determinants of health care costs in HIV-positive patients in Germany: results of the DAGNÄ K3A Study. Eur J Health Econ. 2013;14(5):799-808. https://doi.org/10.1007/s10198-012-0425-4 PMID: 22990377
-
Federal Office of Statistics (Statistisches Bundesamt). Harmonisierter Verbraucherpreisindex (inkl. Veränderungsraten): Deutschland, Jahre. [Harmonised consumer price index (including rates of change)]. Wiesbaden: Statistisches Bundesamt. [Accessed: 19 Jul 2017]. German. Available from: https://www-genesis.destatis.de/genesis/online/data;jsessionid=F50037A5E2FCEDC8499216ECFCAE0D2F.tomcat_GO_2_3?operation=begriffsRecherche&suchanweisung_language=de&suchanweisung=Harmonisierter+Verbraucherpreisindex.
-
Abteilung für Infektionsepidemiologie. HIV-1 Serokonverterstudie. [HIV-1 seroconverter study]. Berlin: Robert Koch-Institut. [Accessed: 17 Oct 2017]. German. Available from: https://www.rki.de/DE/Content/InfAZ/H/HIVAIDS/Studien/SeroKon/SeroKon_node.html Accessed February 7th 2019
-
Bill and Melinda Gates Foundation. Methods for Economic Evaluation Project (MEEP). London: NICE INternational; 2014. Available from: https://www.nice.org.uk/Media/Default/About/what-we-do/NICE-International/projects/MEEP-report.pdf
-
Ong KJ, Desai S, Field N, Desai M, Nardone A, van Hoek AJ, et al. Economic evaluation of HIV pre-exposure prophylaxis among men-who-have-sex-with-men in England in 2016. Euro Surveill. 2017;22(42):22. https://doi.org/10.2807/1560-7917.ES.2017.22.42.17-00192 PMID: 29067902
-
Cambiano V, Miners A, Dunn D, McCormack S, Ong KJ, Gill ON, et al. Cost-effectiveness of pre-exposure prophylaxis for HIV prevention in men who have sex with men in the UK: a modelling study and health economic evaluation. Lancet Infect Dis. 2018;18(1):85-94. https://doi.org/10.1016/S1473-3099(17)30540-6 PMID: 29054789
-
National health care institute (Zorginstituut Nederland). Medicijnkosten. [Pharmacy purchase price]. Diemen: Zorginstituut Nederland. [Accessed: 8 Feb 2019]. Dutch. Available from: www.medicijnkosten.nl
-
Spinner CD, Hanhoff N, Krznaric I, Knecht G, Kuemmerle T, Ruesenberg R, et al. 2016 PREP attitudes in Germany: high awareness and acceptance in MSM at risk of HIV. Infection. 2018;46(3):405-8. https://doi.org/10.1007/s15010-018-1127-3 PMID: 29478091
-
Hoornenborg E, Achterbergh RC, van der Loeff MFS, Davidovich U, van der Helm JJ, Hogewoning A, et al. Men who have sex with men more often chose daily than event-driven use of pre-exposure prophylaxis: baseline analysis of a demonstration study in Amsterdam. J Int AIDS Soc. 2018;21(3):e25105. https://doi.org/10.1002/jia2.25105 PMID: 29603900
-
Sax PE, Wohl D, Yin MT, Post F, DeJesus E, Saag M, et al. Tenofovir alafenamide versus tenofovir disoproxil fumarate, coformulated with elvitegravir, cobicistat, and emtricitabine, for initial treatment of HIV-1 infection: two randomised, double-blind, phase 3, non-inferiority trials. Lancet. 2015;385(9987):2606-15. https://doi.org/10.1016/S0140-6736(15)60616-X PMID: 25890673
-
Bickel M, Wyen C, Spinner CD, Baumgarten A, Jaeger H, Postel N, et al. Switch from tenofovir disoproxil fumarate (TDF)- to tenofovir alafenamide (TAF)-based regimens in clinical practice: real-world data of the German PROPHET cohort study. Conference Poster P112. HIV Glasgow; 28–31 October 2018, Glasgow, United Kingdom. J Int AIDS Soc. 2018;21(S8):e25187.
-
McCormack PL. Dolutegravir: a review of its use in the management of HIV-1 infection in adolescents and adults. Drugs. 2014;74(11):1241-52. https://doi.org/10.1007/s40265-014-0256-y PMID: 25005775
-
Nichols BE, Sigaloff KC, Kityo C, Mandaliya K, Hamers RL, Bertagnolio S, et al. Averted HIV infections due to expanded antiretroviral treatment eligibility offsets risk of transmitted drug resistance: a modeling study. AIDS. 2014;28(1):73-83. https://doi.org/10.1097/01.aids.0000433239.01611.52 PMID: 23921620
-
Kojima N, Davey DJ, Klausner JD. Pre-exposure prophylaxis for HIV infection and new sexually transmitted infections among men who have sex with men. AIDS. 2016;30(14):2251-2. https://doi.org/10.1097/QAD.0000000000001185 PMID: 27314179
-
Hoornenborg E, Achterbergh RCA, Schim van der Loeff MF, Davidovich U, Hogewoning A, de Vries HJC, et al. MSM starting preexposure prophylaxis are at risk of hepatitis C virus infection. AIDS. 2017;31(11):1603-10. https://doi.org/10.1097/QAD.0000000000001522 PMID: 28657964
-
Mantovani LG, Cortesi PA, Strazzabosco M. Effective but costly: How to tackle difficult trade-offs in evaluating health improving technologies in liver diseases. Hepatology. 2016;64(4):1331-42. https://doi.org/10.1002/hep.28527 PMID: 26926906
-
Nichols BE, Boucher CA, van Dijk JH, Thuma PE, Nouwen JL, Baltussen R, et al. Cost-effectiveness of pre-exposure prophylaxis (PrEP) in preventing HIV-1 infections in rural Zambia: a modeling study. PLoS One. 2013;8(3):e59549. https://doi.org/10.1371/journal.pone.0059549 PMID: 23527217
-
Brown AE, Mohammed H, Ogaz D, Kirwan PD, Yung M, Nash SG, et al. Fall in new HIV diagnoses among men who have sex with men (MSM) at selected London sexual health clinics since early 2015: testing or treatment or pre-exposure prophylaxis (PrEP)? Euro Surveill. 2017;22(25):30553. https://doi.org/10.2807/1560-7917.ES.2017.22.25.30553 PMID: 28662762
-
Pilcher CD, Joaki G, Hoffman IF, Martinson FE, Mapanje C, Stewart PW, et al. Amplified transmission of HIV-1: comparison of HIV-1 concentrations in semen and blood during acute and chronic infection. AIDS. 2007;21(13):1723-30. https://doi.org/10.1097/QAD.0b013e3281532c82 PMID: 17690570
-
Lodi S, Phillips A, Touloumi G, Geskus R, Meyer L, Thiébaut R, et al. Time from human immunodeficiency virus seroconversion to reaching CD4+ cell count thresholds <200, <350, and <500 Cells/mm3: assessment of need following changes in treatment guidelines. Clin Infect Dis. 2011;53(8):817-25. https://doi.org/10.1093/cid/cir494 PMID: 21921225
-
Nakagawa F, Lodwick RK, Smith CJ, Smith R, Cambiano V, Lundgren JD, et al. Projected life expectancy of people with HIV according to timing of diagnosis. AIDS. 2012;26(3):335-43. https://doi.org/10.1097/QAD.0b013e32834dcec9 PMID: 22089374

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