Presentation (CTI)

OBJECTIVES: As multiple PrEP strategies are now available or emerging, health economic evaluations are needed to compare costs and outcomes and to inform efficient resource allocation and policy decision-making.
METHODS: A targeted literature review (TLR) has been conducted using PubMed from 2000 to 2024 to identify economic evaluations of PrEP strategies. Evaluations submitted to national authorities (Haute Autorité de Santé [HAS] and National Institute for Health and Care Excellence [NICE]) were also retrieved. Key model details such as model structure, assumptions on treatment pathway, quality of life and cost implementation were extracted.
RESULTS: A total of 341 articles were identified, and 12 were retrieved for review. Almost half of economic evaluations (n=6) were based on a Markov model. All Markov models were based on at least one state associated to PrEP, one or more states associated to HIV and one state associated to death. One of the Markov model structures identified was also used in an economic evaluation of cabotegravir submitted to NICE, which also included a state related to PrEP discontinuation. Second most used model structure was patient-level simulation (n=5) which allowed for a detailed simulation of the natural history of the disease. One study used a net-benefit regression model. Time horizons varied between studies, ranging from 3 years to lifetime. Most studies (n=9) reported results as incremental cost-utility ratio. Other studies focused only on clinical outcomes or did not implemented quality of life data.
CONCLUSIONS: Economic evaluations of PrEP strategies rely on heterogeneous modelling approaches, with Markov models and patient-level simulations being the most frequently used. These findings highlight the importance of selecting model structures that are aligned with the decision problem and the specific features of PrEP strategies.