Cost-effectiveness analysis of HIV pre-exposure prophylaxis in Japan

Figures & data

Figure 1. Markov model structure. Abbreviations, AIDS, acquired immune deficiency syndrome (infected with AIDS); HIV, human immunodeficiency virus; MSM, men who have sex with men; PrEP, pre-exposure prophylaxis.

Table 1. Drug costs.

	Strength	Dosage form	Dosage	Unit/daily cost	Cost per cycle
PrEP	200 mg FTC / 300 mg TDF	Tablet	Once daily	¥2509	¥76,368	^26
ART	See Appendix Table S2	Tablet	Once daily	¥6979	¥212,243	^27

Abbreviations. ART, antiretroviral therapy; PrEP, pre-exposure prophylaxis.

Table 2. Disease monitoring and general medical costs.

Healthcare resource use	Number of tests per year	Unit cost	Cost /month*	Source
HIV test related costs (Sd, Sdp, and Snp health states)
HIV rapid test	4	¥3080	¥1027	^42
HIV confirmation test	Once over time horizon	¥10,540	¥11	^42
STI tests (non-AIDS health states)
Chlamydia and gonorrhea	4	¥2700	¥1434	^42
Syphilis	4	¥1340		^42
Hepatitis C virus	1	¥1050		^42
Hepatitis B virus	Once upon HIV diagnosis	¥880	¥0.08	^42
STI test related cost (Sp, Sdp, and Snp health states only)
Microbiological test interpretation fee	4	¥1500	¥500	^42
STI tests (AIDS health states)
Chlamydia and gonorrhea	12	¥2700	¥4128	^42
Syphilis	12	¥1340		^42
Hepatitis C virus	1	¥1050		^42
Hepatitis B virus	Once upon HIV diagnosis	¥880	¥0.04	^42
Monitoring tests (HIV)
CD4 count test	4	¥1850	¥3453	^42
Immunological test interpretation fee	4	¥1440		^42
HV-1RNA	4	¥5200		^42
Microbiological test interpretation fee	4	¥1500		^42
Blood drawing	4	¥370		^42
Monitoring tests (AIDS)
CD4 count test	24	¥1850	¥17,780	^42
CD4 count test interpretation fee	12	¥1440		^42
HV-1RNA	24	¥5200		^42
HV-1RNA test interpretation fee	12	¥1500		^42
Blood drawing	24	¥370		^42
Hospital costs
Inpatient – HIV	Per probability	¥1,010,000	¥4208	^43
Inpatient – AIDS	Per probability	¥1,480,000	¥109,520	^43
General medical costs
Consultation fee: non-AIDS health state	4	¥730	¥243	^42
Consultation fee: AIDS health state	24	¥730	¥1460	^42
Prescription fee: Sp/HIV health state	4	¥680	¥227	^42
Prescription fee: AIDS health state	24	¥680	¥1360	^42
Pharmacy fee: Sp/HIV health state	4	¥950	¥317	^28
Pharmacy fee: AIDS health state	24	¥950	¥1900	^28

^a weighted average.

Abbreviations, AIDS, acquired immune deficiency syndrome (infected with AIDS); ART, antiretroviral therapy; HIV, human immunodeficiency virus (HIV infected without AIDS); PrEP, pre-exposure prophylaxis; Sdp, “susceptible discontinued PrEP” health state; Snp, “susceptible not on PrEP” health state; Sp, "susceptible on PrEP” health state; STI, sexually transmitted infection.

Table 3. Utility inputs.

Health states	Utility	Source
Sp	0.953	^44
Sdp	0.953	^44
Snp	0.953	^44
HIV	0.843	Calculated using a disutility of 0.11^45
AIDS	0.403	Calculated using a disutility of 0.55^13

Abbreviations. AIDS, acquired immune deficiency syndrome (infected with AIDS); HIV, human immunodeficiency virus (HIV infected without AIDS); PrEP, pre-exposure prophylaxis; Sdp, susceptible discontinued PrEP; Snp, susceptible not on PrEP; Sp, susceptible on PrEP.

Table 4. Cost outcomes per individual over time horizon, Japan.

	Drug cost^a	Monitoring cost	General medical cost	Total costs	Difference
With PrEP	¥22,270,834	¥772,092	¥1,454,083	¥24,497,009	-¥5168
Without PrEP	¥21,143,189	¥876,632	¥2,482,356	¥24,502,177

Abbreviations. PrEP, pre-exposure prophylaxis.

^a Includes the cost of drugs for both PrEP and antiretroviral therapy.

Figure 2. Annual total (A) and cumulative (B) lifetime costs, Japan.

Table 5. Cost-effectiveness results (per individual), Japan.

	Total costs	Total LYs	Total QALYs	Incremental costs	Incremental QALYs	ICER
With PrEP	¥24,497,009	22.33	20.57
Without PrEP	¥24,502,177	22.02	19.41	-¥5168	1.16	Intervention dominates^a

^a Scenario with PrEP costs less and is more effective than the scenario without PrEP.

Abbreviations. ICER, incremental cost-effectiveness ratio; PrEP, pre-exposure prophylaxis; QALYs, quality adjusted life years.

Figure 3. ICER scatterplot for the 47 prefectures. Note: prefectures in the shaded green portion of the graph are considered to be cost-effective (< ¥5,000,0000 per QALY).

Abbreviations. ICER, incremental cost-effectiveness ratio; QALYs, quality adjusted life years.

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Data availability statement

The data and model informing this analysis are available upon reasonable request.