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Demeulemeester R, Savy N, Mounié M, Molinier L, Delpierre C, Dellamonica P, Allavena C, Pugliesse P, Cuzin L, Saint-Pierre P, Costa N. Economic impact of generic antiretrovirals in France for HIV patients' care: a simulation between 2019 and 2023. BMC Health Serv Res 2022; 22:567. [PMID: 35477443 PMCID: PMC9044646 DOI: 10.1186/s12913-022-07859-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 03/29/2022] [Indexed: 11/17/2022] Open
Abstract
Background In a context where the economic burden of HIV is increasing as HIV patients now have a close to normal lifespan, the availability of generic antiretrovirals commonly prescribed in 2017 and the imminence of patent expiration are expected to provide substantial savings in the coming years. This article aims to assess the economic impact of these generic antiretrovirals in France and specifically over a five-year period. Methods An agent-based model was developed to simulate patient trajectories and treatment use over a five-year period. By comparing the results of costs for trajectories simulated under different predefined scenarios, a budget impact model can be created and sensitivity analyses performed on several parameters of importance. Results The potential economic savings from 2019 to 2023 generated by generic antiretrovirals range from €309 million when the penetration rate of generics is set at 10% to €1.5 billion at 70%. These savings range from €984 million to €993 million as the delay between patent and generic marketing authorisation varies from 10 to 15 years, and from €965 million to €993 million as the Negotiated Price per Unit (NPU) of generics at market-entry varies from 40 to 50% of the NPU for patents. Discussion This economic savings simulation could help decision makers to anticipate resource allocations for further innovation in antiretrovirals therapies as well as prevention, especially by funding the Pre-Exposure Prophylaxis (PrEP) or HIV screening. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-07859-w.
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Affiliation(s)
- Romain Demeulemeester
- University of Toulouse III, 31330, Toulouse, France. .,Health Economics Unit, Medical Information Department, University Hospital of Toulouse, Toulouse, France. .,UMR 1295, National Institute for Health and Medical Research, Toulouse, France. .,Faculté de Médecine, Université Paul Sabatier, INSERM, UMR 1295, 37 allées Jules Guesde, 31000, Toulouse, France.
| | - Nicolas Savy
- University of Toulouse III, 31330, Toulouse, France.,CNRS UMR 5219, Toulouse Mathematics Institute, Toulouse, France
| | - Michaël Mounié
- Health Economics Unit, Medical Information Department, University Hospital of Toulouse, Toulouse, France.,UMR 1295, National Institute for Health and Medical Research, Toulouse, France
| | - Laurent Molinier
- University of Toulouse III, 31330, Toulouse, France.,Health Economics Unit, Medical Information Department, University Hospital of Toulouse, Toulouse, France.,UMR 1295, National Institute for Health and Medical Research, Toulouse, France
| | - Cyrille Delpierre
- University of Toulouse III, 31330, Toulouse, France.,UMR 1295, National Institute for Health and Medical Research, Toulouse, France
| | - Pierre Dellamonica
- Infectious Diseases Department, University of Côte d'Azur, University Hospital of Nice, Nice, France
| | - Clotilde Allavena
- Infectious Diseases Department, University Hospital of Nantes, Nantes, France
| | - Pascal Pugliesse
- Infectious Diseases Department, University of Côte d'Azur, University Hospital of Nice, Nice, France
| | - Lise Cuzin
- UMR 1295, National Institute for Health and Medical Research, Toulouse, France.,Infectious and Tropical Diseases Department, University Hospital of Martinique, Fort-de-France, France
| | - Philippe Saint-Pierre
- University of Toulouse III, 31330, Toulouse, France.,CNRS UMR 5219, Toulouse Mathematics Institute, Toulouse, France
| | - Nadège Costa
- Health Economics Unit, Medical Information Department, University Hospital of Toulouse, Toulouse, France.,UMR 1295, National Institute for Health and Medical Research, Toulouse, France
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Sepodes B, Rocha J, Batista J, Figueira ME, Dráfi F, Torre C. Implementation and Access to Pre-exposure Prophylaxis for Human Immunodeficiency Virus by Men Who Have Sex With Men in Europe. Front Med (Lausanne) 2021; 8:722247. [PMID: 34513883 PMCID: PMC8424070 DOI: 10.3389/fmed.2021.722247] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 07/23/2021] [Indexed: 11/30/2022] Open
Abstract
Pre-exposure prophylaxis (PrEP) is a significant public health intervention with proven efficacy and safety in the prevention of human immunodeficiency virus (HIV) infection, which has taken a considerable amount of time to reach Europe in relation to their transatlantic counterparts, namely, the United States of America (USA). There, it is perceived as being an essential prevention tool to be integrated within existing medical, behavioral and structural interventions in place for the management and containment of HIV infection in men who have sex with men (MSM). In a region such as Europe, with approximately double the USA population, it is estimated that not even 10% have proper access to PrEP, and given the lack of coordination with healthcare, taking PrEP has to be at their own expense. Here, we identify the reasons behind the 4-year lag in the approval of PrEP in the European Union/European Economic Area (and Europe in general) and explore the efficacy and effectiveness of PrEP needed to be confirmed with some implementation or demonstration studies conducted in the region. Independent of the data gathered, access of MSM to PrEP is far from ideal in Europe and much still needs to be done. The demonstration of the cost-effectiveness of PrEP alongside other social and behavioral factors needs to be addressed, while the clear populations within MSM that will benefit from this intervention are properly identified and make use of the latest recommendations of the World Health Organization that consider not only daily PrEP but also event-driven PrEP. The momentum for the proper implementation of PrEP in the EU is not lost, and with the existence of generics and even new formulations, there is a renewed opportunity for unleashing the public health benefits arising from this pharmacological tool with other interventions in place (e.g., condoms, testing, and counseling).
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Affiliation(s)
- Bruno Sepodes
- Faculdade de Farmácia da Universidade de Lisboa, Department of Pharmacy, Pharmacology and Health Technologies, Lisbon, Portugal.,Laboratory of Systems Integration Pharmacology, Clinical & Regulatory Science-Research Institute for Medicines of the University of Lisbon (iMED.ULisboa), Lisbon, Portugal
| | - João Rocha
- Faculdade de Farmácia da Universidade de Lisboa, Department of Pharmacy, Pharmacology and Health Technologies, Lisbon, Portugal.,Laboratory of Systems Integration Pharmacology, Clinical & Regulatory Science-Research Institute for Medicines of the University of Lisbon (iMED.ULisboa), Lisbon, Portugal
| | - Jorge Batista
- Unidade de Saúde Pública Internacional e Bioestatística, Instituto de Higiene e Medicina Tropical, Universidade NOVA de Lisboa, Lisbon, Portugal
| | - Maria-Eduardo Figueira
- Laboratory of Systems Integration Pharmacology, Clinical & Regulatory Science-Research Institute for Medicines of the University of Lisbon (iMED.ULisboa), Lisbon, Portugal.,Faculdade de Farmácia da Universidade de Lisboa, Department of Pharmaceutical Sciences and Medicines, Lisbon, Portugal
| | - František Dráfi
- Institute of Experimental Pharmacology and Toxicology, Centre of Experimental Medicine of the Slovak Academy of Sciences, Bratislava, Slovakia
| | - Carla Torre
- Faculdade de Farmácia da Universidade de Lisboa, Department of Pharmacy, Pharmacology and Health Technologies, Lisbon, Portugal.,Laboratory of Systems Integration Pharmacology, Clinical & Regulatory Science-Research Institute for Medicines of the University of Lisbon (iMED.ULisboa), Lisbon, Portugal
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Estimated Number of Men Who Have Sex With Men With Indications for HIV Pre-exposure Prophylaxis in a National Sexual Network Study. J Acquir Immune Defic Syndr 2020; 84:10-17. [PMID: 31939869 DOI: 10.1097/qai.0000000000002300] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND A 2015 CDC analysis estimated that 24.7% of sexually active men who have sex with men (MSM) had indications for HIV pre-exposure prophylaxis (PrEP) based on 2014 US Public Health Service (USPHS) clinical practice guidelines. Given that the USPHS revised these guidelines in 2017, updated estimates of the fraction of MSM indicated for PrEP overall and stratified by demographic factors and geography are needed to scale-up PrEP for MSM in the US. METHODS We conducted a national web-based study of 4904 MSM aged 15-65 who had ever had sex with another man between July 2017 and January 2019. We estimated the percentage of HIV-negative, sexually active MSM meeting USPHS indications for PrEP by demographic category. RESULTS Of 3511 sexually active, HIV-negative MSM, 34.0% (95% confidence interval: 32.4 to 35.6) met USPHS indications for PrEP, with percentages consistent across US census region and varying slightly by race/ethnicity (Black: 32.2%, White: 33.7%, Hispanic: 36.4%, Other: 33.6%). Among individuals meeting USPHS PrEP indications, 93.5% reported condomless anal intercourse in the prior 6 months. Among all survey respondents, PrEP eligibility was lowest among non-Hispanic black (18.4%) and younger respondents (15-17: 4.1%; 18-24: 18.1%). CONCLUSIONS Estimated percentages of MSM meeting indications for PrEP exceeded the previous CDC estimate across race/ethnicity, age, and census regions, with one-third of adult, sexually active, HIV-negative MSM exhibiting indications for PrEP. This study suggests, given current guidelines for PrEP indications, that a different fraction of eligible MSM could be receiving PrEP than previously estimated.
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Caumes E. [Alarming reemergence of sexually transmitted infections in the PrEP area: Why not come back to safer sex?]. Presse Med 2018; 47:719-721. [PMID: 30368404 DOI: 10.1016/j.lpm.2018.09.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Affiliation(s)
- Eric Caumes
- Assistance publique des hôpitaux de Paris (AP-HP), hôpitaux universitaires Pitié-Salpêtrière Charles-Foix, Sorbonne université, service de maladies infectieuses et tropicales, 75013 Paris, France.
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Wang Z, Lau JTF, Fang Y, Ip M, Gross DL. Prevalence of actual uptake and willingness to use pre-exposure prophylaxis to prevent HIV acquisition among men who have sex with men in Hong Kong, China. PLoS One 2018; 13:e0191671. [PMID: 29432470 PMCID: PMC5809018 DOI: 10.1371/journal.pone.0191671] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Accepted: 01/09/2018] [Indexed: 01/02/2023] Open
Abstract
OBJECTIVES This study was to investigate the prevalence of actual uptake of pre-exposure prophylaxis (PrEP), willingness to use daily oral PrEP under two cost scenarios, and potential issues related to PrEP use among men who have sex with men (MSM) with HIV negative/unknown sero-status in Hong Kong, China. Factors associated with the two measures of willingness were also investigated. METHODS 403 eligible MSM completed the anonymous venue-based face-to-face interview/telephone interview. RESULTS Only 1% had ever used PrEP. After being briefed about some facts of PrEP, the prevalence of willingness to use daily oral PrEP was 7.7% if they could purchase PrEP at private hospitals/clinics at HK$8,000 (US$1,032)/month (market rate) and 45.2% if free PrEP was provided by public hospitals/clinics in Hong Kong (free PrEP). After adjusted for significant background variables, significant factors of these two measures of willingness included: (1) number of correct responses to knowledge on PrEP, (2) perceived risk of HIV infection in the next six months, and (3) constructs of the Theory of Planned Behavior: positive and negative attitudes toward PrEP, perceived their significant others would support them take PrEP (perceived subjective norm), perceived number of local MSM who were willing to take PrEP (perceived descriptive norm), and confidence in using PrEP under the two scenarios (perceived behavioral control). Among all participants, 9.7% and 25.1% would start and discontinue using PrEP without consulting doctors; 26.0% would not take PrEP daily if it was provided for free, and 42.4% would not take up HIV testing every 3 months after using PrEP. CONCLUSION Different strategies should be considered for promoting PrEP at market rate and if free PrEP is made available. Future promotion should increase their knowledge about PrEP, modify their perceptions related to HIV and PrEP, and address some potential issues related to PrEP use.
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Affiliation(s)
- Zixin Wang
- Centre for Health Behaviours Research, JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong SAR, China
- Shenzhen Research Institute, The Chinese University of Hong Kong, Shenzhen, China
- Community Research Program on AIDS, JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong SAR, China
- * E-mail: (ZW); (JTFL)
| | - Joseph T. F. Lau
- Centre for Health Behaviours Research, JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong SAR, China
- Shenzhen Research Institute, The Chinese University of Hong Kong, Shenzhen, China
- * E-mail: (ZW); (JTFL)
| | - Yuan Fang
- Centre for Health Behaviours Research, JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Mary Ip
- Centre for Health Behaviours Research, JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Danielle L. Gross
- Centre for Health Behaviours Research, JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong SAR, China
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Kieran JA, O'Reilly E, O'Dea S, Bergin C, O'Leary A. Generic substitution of antiretrovirals: patients' and health care providers' opinions. Int J STD AIDS 2017. [PMID: 28632475 PMCID: PMC5606299 DOI: 10.1177/0956462417696215] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
There is interest in introducing generic antiretroviral drugs (ARVs) into high-income countries in order to maximise efficiency in health care budgets. Studies examining patients' and providers' knowledge and attitudes to generic substitution in HIV are few. This was a cross-sectional, observational study with a convenience sample of adult HIV-infected patients and health care providers (HCPs). Data on demographics, knowledge of generic medicine and facilitators of generic substitution were collected. Descriptive and univariate analysis was performed using SPSS V.23™. Questionnaires were completed by 66 patients. Seventy-one per cent would have no concerns with the introduction of generic ARVs. An increase in frequency of administration (61%) or pill burden (53%) would make patients less likely to accept generic ARVs. There were 30 respondents to the HCP survey. Concerns included the supply chain of generics, loss of fixed dose combinations, adherence and use of older medications. An increase in dosing frequency (76%) or an increase in pill burden (50%) would make HCPs less likely to prescribe a generic ARV. The main perceived advantage was financial. Generic substitution of ARVs would be acceptable to the majority of patients and HCPs. Reinvesting savings back into HIV services would facilitate the success of such a programme.
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Affiliation(s)
- Jennifer A Kieran
- 1 Department of Genitourinary Medicine and Infectious Disease, St James Hospital, Dublin, Ireland.,2 National Centre for Pharmacoeconomics, St James Hospital, Dublin, Ireland
| | - Eimear O'Reilly
- 3 School of Pharmacy, Royal College of Surgeons Ireland, Dublin, Ireland
| | - Siobhan O'Dea
- 1 Department of Genitourinary Medicine and Infectious Disease, St James Hospital, Dublin, Ireland
| | - Colm Bergin
- 1 Department of Genitourinary Medicine and Infectious Disease, St James Hospital, Dublin, Ireland.,4 Department of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Aisling O'Leary
- 2 National Centre for Pharmacoeconomics, St James Hospital, Dublin, Ireland.,3 School of Pharmacy, Royal College of Surgeons Ireland, Dublin, Ireland
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Nichols BE, Boucher CAB, van der Valk M, Rijnders BJA, van de Vijver DAMC. Cost-effectiveness analysis of pre-exposure prophylaxis for HIV-1 prevention in the Netherlands: a mathematical modelling study. THE LANCET. INFECTIOUS DISEASES 2016; 16:1423-1429. [PMID: 27665989 DOI: 10.1016/s1473-3099(16)30311-5] [Citation(s) in RCA: 67] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Revised: 07/25/2016] [Accepted: 08/01/2016] [Indexed: 12/15/2022]
Abstract
BACKGROUND Pre-exposure prophylaxis (PrEP) with tenofovir and emtricitabine prevents HIV infections among men who have sex with men (MSM). PrEP can be given on a daily or intermittent basis. Unfortunately, PrEP is not reimbursed in most European countries. Cost-effectiveness analyses of PrEP among MSM in Europe are absent but are key for decision makers to decide upon PrEP implementation. METHODS We developed a deterministic mathematical model, calibrated to the well defined Dutch HIV epidemic among MSM, to predict the effect and cost-effectiveness of PrEP. PrEP was targeted to 10% of highly sexually active Dutch MSM over the coming 40 years. Cost-effectiveness ratios were calculated to predict the cost-effectiveness of daily and on-demand PrEP. Cost-effectiveness ratios below €20 000 were considered to be cost-effective in this analysis. FINDINGS Within the context of a stable HIV epidemic, at 80% effectiveness and current PrEP pricing, PrEP can cost as much as €11 000 (IQR 9400-14 100) per quality-adjusted life-year (QALY) gained when used daily, or as little as €2000 (IQR 1300-3000) per QALY gained when used on demand. At 80% effectiveness, daily PrEP can be considered cost-saving if the price of PrEP is reduced by 70%, and on-demand PrEP can be considered cost-saving if the price is reduced by 30-40%. INTERPRETATION PrEP for HIV prevention among MSM in the Netherlands is cost-effective. The use of PrEP is most cost-effective when the price of PrEP is reduced through on-demand use or through availability of generic PrEP, and can quickly be considered cost-saving. FUNDING None.
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Affiliation(s)
- Brooke E Nichols
- Department of Viroscience, Erasmus Medical Center, Rotterdam, Netherlands.
| | | | - Marc van der Valk
- Department of Internal Medicine, Division of Infectious Diseases, Center for Infection and Immunity Amsterdam, Academic Medical Center, Amsterdam, Netherlands
| | - Bart J A Rijnders
- Department of Internal Medicine, Section Infectious Diseases, Erasmus Medical Center, Rotterdam, Netherlands
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