HIQA reviewing a PrEP programme for Ireland in 2019

Ten of Swords

HIQA are beginning an analysis on the clinical significance and cost benefits of rolling out a fully subsidized PrEP programme for people at high risk of HIV in Ireland in 2019. I think this is a hugely encouraging step and would bring the HSE in line with many other European nations (11 EU countries publicly fund PrEP currently). Men who have sex with men are the highest risk category, representing approx 50% of new diagnoses each year.

From a purely economic point of view I can't see why this rollout would not be accepted. A months supply of generic PrEP is €90~€100 (market rate) so that works back to about €3 per day. I assume the HSE could source that cheaper. The current situation is the HSE covering the cost of HIV treatments each month for the rest of the patients life and year on year there are approx 500 new cases. Surely PrEP has to be the cheaper long term option.

Publicly funded PrEP does not mean responsibility for your own sexual health is abdicated but prevention of any future diagnoses should be encouraged.

HIQA announcement

Irish Examiner

Ten of Swords

HIQA have published their report on PrEP and are beginning a public consultation phase. This is very good news imo, and long overdue. The report is here, it is a very detailed document and contains a lot of statistical and scientific data but the key points are certainly worth a read

https://www.hiqa.ie/sites/default/files/2019-04/PrEP-HTA-for-public-consultation.pdf

1) This cross-sectional population model tracks all HIV-negative Irish gay, bisexual and other men who have sex with men (MSM) at the outset of the simulation (2018) and follows these men over their lifetime. While a prospective PrEP programme would enrol all eligible participants and not exclusively MSM at substantial risk, only MSM are considered for the purposes of cost-effectiveness modelling due to the fact that more than 95% of participants are expected to be MSM and very limited data were retrieved on other groups.

2) In the base case analysis, PrEP is cost saving, with an incremental cost-effectiveness ratio (ICER) of -€2,735 over the cohort’s lifetime (95% CI: -€16,486 to €21,585). This means that providing PrEP is less costly, and more effective (in terms of quality-adjusted life years [QALYs] gained), than not providing PrEP.

3) The mean number of people estimated to join a potential PrEP programme in Year 1 is 1,705 people (95% CI: 617 to 3,452).

4) The incremental budget impact of the PrEP programme is €1.5m in the first year (95% CI: €0.5m to €3m) and €5.4m over 5 years (95% CI: €1.8m to €11.5m)