Epidemiological impacts and cost-effectiveness of daily and on-demand oral pre-exposure prophylaxis among key HIV populations in China: An economic evaluation

Abstract

This study assessed the impact and cost-effectiveness of pre-exposure prophylaxis (PrEP) in reducing HIV infections and HIV-related deaths among four key populations in China: men who have sex with men (MSM). Female sex workers (FSW), people who inject drugs (PWID), and HIV-negative partners of serodiscordant couples (SDC). Decision-analytic Markov models simulated HIV transmission and progression in cohorts of 100,000 adults over 40 years under three strategies: no PrEP, daily oral PrEP, and on-demand oral PrEP evaluated nationaly and high-incidence provinces. Cost-effectiveness was measured using a willingness-to-pay threshold of US$37,653 per QALY. Across all populations, on-demand PrEP was the most cost-effective strategy. Among MSM, it was cost-effective both nationwide (ICER: $4,554/QALY) and in high-incidence provinces (ICER: $1,045-2,129/QALY), reducing new infections by 24.7%. Daily PrEP was also const-effective for MSM nationally and prevented 19.9% of infections. For FSW, on-demand PrEP was cost-effective in high-incidence provinces (ICER: $25,399-37,045/QALY), reducing infections by 21.8%-22.5%. For PWID, it was cost-effective in high-incidence provinces (ICER: $10,361-29,560/QALY), reducing infections by 15.5%-17.9%. For HIV-negative partners of SDC, on-demand PrEP was cost-effective both nationally and in high-incidence provinces, reducing infections by 24.0%. Overall, on-demand PrEP offers substantial health and economic benefits, particularly for HIV-negative partners of SDC and high-incidence regions.