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<p>In the European Union (EU), HIV disproportionately affects men who have sex with men (MSM), with prevalence rates ranging from 2.4% to 29%. Pre-exposure prophylaxis (PrEP) is highly effective in preventing HIV, yet access and uptake remain uneven. We used a stochastic agent-based model of HIV transmission among MSM to evaluate the effectiveness and cost-effectiveness of five PrEP eligibility policies across 20 EU countries, incorporating data on sexual behavior, adherence, and healthcare costs. US, CDC and Belgian guidelines, which recommend broad eligibility, achieved the highest reductions in HIV infections and deaths, whereas WHO guidelines consistently emerged as the most cost-effective option, particularly in countries with constrained budgets. Our analyses further show that lowering drug costs would expand the range of cost-effective options in settings without PrEP reimbursement. Finally, we estimated willingness-to-pay thresholds for injectable, long-acting PrEP. Long-acting injectable formulations are emerging as new PrEP options. Current prices largely exceed these thresholds, but cabotegravir could approach cost-effectiveness under WHO guidelines in some countries. Overall, broad eligibility criteria maximize effectiveness, while WHO guidelines balance affordability and impact. Expanding oral PrEP access and reducing drug costs remain essential for HIV prevention in Europe, while injectable PrEP is likely to require substantial price reductions or targeted use in selected populations to become economically attractive. Our findings highlight the need for policy adjustments to improve PrEP accessibility, inform national health strategies, and achieve sustainable HIV prevention across diverse settings.</p>

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Comparing the cost-effectiveness of alternative policies for recommending and providing HIV pre-exposure prophylaxis to men who have sex with men in the EU

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年6月23日

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  • Boxuan Wang,
  • João Brázia,
  • Andreia Sofia Teixeira,
  • Eugenio Valdano

摘要

In the European Union (EU), HIV disproportionately affects men who have sex with men (MSM), with prevalence rates ranging from 2.4% to 29%. Pre-exposure prophylaxis (PrEP) is highly effective in preventing HIV, yet access and uptake remain uneven. We used a stochastic agent-based model of HIV transmission among MSM to evaluate the effectiveness and cost-effectiveness of five PrEP eligibility policies across 20 EU countries, incorporating data on sexual behavior, adherence, and healthcare costs. US, CDC and Belgian guidelines, which recommend broad eligibility, achieved the highest reductions in HIV infections and deaths, whereas WHO guidelines consistently emerged as the most cost-effective option, particularly in countries with constrained budgets. Our analyses further show that lowering drug costs would expand the range of cost-effective options in settings without PrEP reimbursement. Finally, we estimated willingness-to-pay thresholds for injectable, long-acting PrEP. Long-acting injectable formulations are emerging as new PrEP options. Current prices largely exceed these thresholds, but cabotegravir could approach cost-effectiveness under WHO guidelines in some countries. Overall, broad eligibility criteria maximize effectiveness, while WHO guidelines balance affordability and impact. Expanding oral PrEP access and reducing drug costs remain essential for HIV prevention in Europe, while injectable PrEP is likely to require substantial price reductions or targeted use in selected populations to become economically attractive. Our findings highlight the need for policy adjustments to improve PrEP accessibility, inform national health strategies, and achieve sustainable HIV prevention across diverse settings.