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Abstract

Background

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%.

Aim

Our objective was to assess cost-effectiveness and costs of introducing PrEP in Germany.

Methods

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.

Results

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.

Conclusion

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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2019-02-14
2025-05-01
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Cost-effectiveness and budget effect of pre-exposure prophylaxis for HIV-1 prevention in Germany from 2018 to 2058
<p class="citation"> <span>Citation style for this article:</span> <span class="meta-value authors"> <a href="/search?value1=David+A+M+C+van+de+Vijver&option1=author&noRedirect=true" class="nonDisambigAuthorLink">van de Vijver David A M C</a>, <a href="/search?value1=Ann-Kathrin+Richter&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Richter Ann-Kathrin</a>, <a href="/search?value1=Charles+A+B+Boucher&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Boucher Charles A B</a>, <a href="/search?value1=Barbara+Gunsenheimer-Bartmeyer&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Gunsenheimer-Bartmeyer Barbara</a>, <a href="/search?value1=Christian+Kollan&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Kollan Christian</a>, <a href="/search?value1=Brooke+E+Nichols&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Nichols Brooke E</a>, <a href="/search?value1=Christoph+D+Spinner&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Spinner Christoph D</a>, <a href="/search?value1=J%C3%BCrgen+Wasem&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Wasem Jürgen</a>, <a href="/search?value1=Knud+Schewe&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Schewe Knud</a>, <a href="/search?value1=Anja+Neumann&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Neumann Anja</a></span>. Cost-effectiveness and budget effect of pre-exposure prophylaxis for HIV-1 prevention in Germany from 2018 to 2058. <a href="/content/ecdc">Euro Surveill.</a> 2019;24(7):pii=1800398. <a href="https://doi.org/10.2807/1560-7917.ES.2019.24.7.1800398" title="doi link" target="_blank">https://doi.org/10.2807/1560-7917.ES.2019.24.7.1800398</a> <span class="ES_Article_citation"> <span class="generated">Received</span>: 19 Jul 2018;&nbsp;&nbsp; <span class="generated">Accepted</span>: 28 Jan 2019 </span> </p>
/content/10.2807/1560-7917.ES.2019.24.7.1800398
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