Sebastian Vermeersch1, Steven Callens2, Stéphane De Wit3, Jean-Christophe Goffard4, Marie Laga5, Dominique Van Beckhoven6, Lieven Annemans7. 1. a hict , Brugge , Belgium. 2. b Department of Internal Medicine and Infectious Diseases , Ghent University Hospital , Gent , Belgium. 3. c Department of Infectious Diseases , CHU Saint-Pierre , Brussels , Belgium. 4. d Service of Internal Medicine , HIV Reference Centre, ULB - Hôpital Erasme , Brussels , Belgium. 5. e HIV and Sexual Health Unit, Department of Public Health , Institute of Tropical Medicine , Antwerp , Belgium. 6. f Epidemiology of Infectious Diseases Unit , Scientific Institute of Public Health (WIV-ISP) , Brussels , Belgium. 7. g Faculty of Medicine and Health Science, Department of Public Health , Ghent University , Gent , Belgium.
Abstract
OBJECTIVES: We developed a pragmatic modelling approach to estimate the impact of treatment as prevention (TasP); outreach testing strategies; and pre-exposure prophylaxis (PrEP) on the epidemiology of HIV and its associated pharmaceutical expenses. METHODS: Our model estimates the incremental health (in terms of new HIV diagnoses) and budget impact of two prevention scenarios (outreach+TasP and outreach+TasP+PrEP) against a 'no additional prevention' scenario. Model parameters were estimated from reported Belgian epidemiology and literature data. The analysis was performed from a healthcare payer perspective with a 15-year-time horizon. It considers subpopulation differences, HIV infections diagnosed in Belgium having occurred prior to migration, and the effects of an ageing HIV population. RESULTS: Without additional prevention measures, the annual number of new HIV diagnoses rises to over 1350 new diagnoses in 2030 as compared to baseline, resulting in a budget expenditure of €260.5 million. Implementation of outreach+TasP and outreach+TasP+PrEP results in a decrease in the number of new HIV diagnoses to 865 and 663 per year, respectively. Respective budget impacts decrease by €20.6 million and €33.7 million. CONCLUSION: Foregoing additional investments in prevention is not an option. An approach combining TasP, outreach and PrEP is most effective in reducing the number of new HIV diagnoses and the HIV treatment budget. Our model is the first pragmatic HIV model in Belgium estimating the consequences of a combined preventive approach on the HIV epidemiology and its economic burden assuming other prevention efforts such as condom use and harm reduction strategies remain the same.
OBJECTIVES: We developed a pragmatic modelling approach to estimate the impact of treatment as prevention (TasP); outreach testing strategies; and pre-exposure prophylaxis (PrEP) on the epidemiology of HIV and its associated pharmaceutical expenses. METHODS: Our model estimates the incremental health (in terms of new HIV diagnoses) and budget impact of two prevention scenarios (outreach+TasP and outreach+TasP+PrEP) against a 'no additional prevention' scenario. Model parameters were estimated from reported Belgian epidemiology and literature data. The analysis was performed from a healthcare payer perspective with a 15-year-time horizon. It considers subpopulation differences, HIV infections diagnosed in Belgium having occurred prior to migration, and the effects of an ageing HIV population. RESULTS: Without additional prevention measures, the annual number of new HIV diagnoses rises to over 1350 new diagnoses in 2030 as compared to baseline, resulting in a budget expenditure of €260.5 million. Implementation of outreach+TasP and outreach+TasP+PrEP results in a decrease in the number of new HIV diagnoses to 865 and 663 per year, respectively. Respective budget impacts decrease by €20.6 million and €33.7 million. CONCLUSION: Foregoing additional investments in prevention is not an option. An approach combining TasP, outreach and PrEP is most effective in reducing the number of new HIV diagnoses and the HIV treatment budget. Our model is the first pragmatic HIV model in Belgium estimating the consequences of a combined preventive approach on the HIV epidemiology and its economic burden assuming other prevention efforts such as condom use and harm reduction strategies remain the same.
Entities:
Keywords:
HIV; Prevention and control; budgets; health impact assessment; pre-exposure prophylaxis
Authors: Sebastian Vermeersch; Rémy P Demeester; Nathalie Ausselet; Steven Callens; Paul De Munter; Eric Florence; Jean-Christophe Goffard; Sophie Henrard; Patrick Lacor; Peter Messiaen; Agnès Libois; Lucie Seyler; Françoise Uurlings; Stefaan J Vandecasteele; Eric Van Wijngaerden; Jean-Cyr Yombi; Lieven Annemans; Stéphane De Wit Journal: BMC Health Serv Res Date: 2022-01-02 Impact factor: 2.655