Cost-utility Analysis of Universal Pre-exposure Prophylaxis Coverage for Men who have Sex with Men at a High Risk of Human Immunodeficiency Virus Infection in Ontario, Canada

Abstract

HIV pre-exposure prophylaxis (PrEP) was approved by Health Canada in 2016. Currently in Ontario, those under the age of 25 or aged 65 years or older can access PrEP free of charge through public drug coverage programs. This study assessed the cost-effectiveness of providing public coverage for PrEP to all high-risk Ontario MSM. A Markov cohort model was built from the perspective of the Ontario Ministry of Health and Long-Term Care (MOH) using a lifetime time horizon. Health states included HIV positive, HIV negative, and Dead. Transition probabilities, health state utilities and HIV treatment costs were sourced from published literature. Costs of HIV prevention were estimated through a micro-costing approach. HIV infection risk was estimated using the HIRI-MSM screening tool. Offering PrEP to all high-risk MSM through the Ontario MOH is dominant to current coverage circumstances due to a reduction in costly HIV infections.M.Sc