O-45 Estimation of the potential effectiveness and cost-effectiveness of HIV pre-exposure prophylaxis for STI clinic attendees in Jamaica
Author(s):
I.J. Rao, M.L. Brandeau, G.J. Barrow
Year of Presentation:
2023
Objective: To assess the potential effectiveness and costeffectiveness of HIV pre-exposure prophylaxis (PrEP) provision for patients at sexually transmitted infection (STI)
clinics in Jamaica.
Methods: We considered the provision of oral PrEP to STI clinic attendees and compared it to standard STI care without PrEP. Data on STI clinic attendees was based on a retrospective record review in the Western Health Region of Jamaica. PrEP clinic cost estimates were obtained from data reported by the Jamaica Ministry of Health and Wellness. HIV care costs were obtained from a retrospective record review of 150 HIV-positive patients attending a hospitalbased HIV treatment clinic in Kingston, Jamaica. We used a Markov model to track patient HIV status and care costs over a 30-year time horizon, both for individuals on PrEP and individuals not on PrEP, and measured costs and quality-adjusted life years (QALYs).
Results: The estimated incremental cost per QALY gained for a patient on PrEP is JMD$1,123,007. In sensitivity analysis, PrEP was still cost-effective at a threshold of three times the GDP per capita of Jamaica even if the annual cost of PrEP is doubled compared to the base case (JMD$36,000 vs JMD$18,682), or if HIV incidence is approximately half as high as we estimated in the base case (0.15% vs 0.27%).
Conclusion: PrEP provision at STI clinics in Jamaica is likely to be effective in reducing HIV transmission and is likely to be cost-effective when using a willingness-to-pay threshold of three times the GDP per capita.