Cost-effectiveness of HIV prevention interventions in sub-Saharan Africa (2019-2025): a systematic review.

IF 1.5 4区医学 Q3 HEALTH CARE SCIENCES & SERVICES

Expert Review of Pharmacoeconomics & Outcomes Research Pub Date : 2025-10-07 DOI:10.1080/14737167.2025.2570695

Christopher Mugari, Akim Tafadzwa Lukwa, Denis Okova, Plaxcedes Chiwire, Mickaël Hiligsmann

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引用次数: 0

Abstract

Introduction: This systematic review synthesizes recent evidence on the cost-effectiveness of HIV prevention interventions in sub-Saharan Africa (SSA), where over 70% of the global HIV burden resides.

Methods: Following PRISMA 2020 guidelines, we searched five databases (2019-2025) for full economic evaluations of HIV prevention in SSA. Studies were assessed using CHEERS 2022 and Drummond checklists. Costs were adjusted to 2024 USD and compared to GDP per capita thresholds. Results were synthesized narratively.

Results: 30 studies were included; 28 used model-based designs, 2 used trial or cohort data. The most frequently evaluated interventions were PrEP (n = 7), PMTCT (n = 4), and HIV testing innovations (n = 3). Oral PrEP was the dominant form, though two studies evaluated long-acting injectable PrEP. Interventions were considered cost-effective if the Incremental Cost Effectiveness Ratio (ICER) was below 1-3 times GDP per capita. For example, dolutegravir-based PMTCT had an ICER of USD109/DALY averted. Peer-delivered self-testing and maternal HIV screening in immunization clinics showed strong economic efficiency. Few studies incorporated real-world data on medication adherence, drop-out or service delivery costs.

Conclusions: Targeted, integrated HIV prevention strategies are cost-effective in SSA. Future studies should improve use of empirical adherence and implementation data and expand focus to underrepresented populations and regions.

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撒哈拉以南非洲地区艾滋病毒预防干预措施的成本效益（2019-2025）：系统回顾。

本系统综述综合了撒哈拉以南非洲（SSA）艾滋病毒预防干预措施成本效益的最新证据，该地区占全球艾滋病毒负担的70%以上。方法：根据PRISMA 2020指南，我们检索了五个数据库（2019-2025），对SSA的艾滋病毒预防进行全面的经济评估。研究使用CHEERS 2022和Drummond清单进行评估。成本调整为2024美元，并与人均GDP阈值进行比较。对结果进行叙述性综合。结果：纳入30项研究；28个采用基于模型的设计，2个采用试验或队列数据。最常被评估的干预措施是PrEP （n = 7）、PMTCT （n = 4）和HIV检测创新（n = 3）。口服PrEP是主要形式，尽管有两项研究评估了长效注射PrEP。如果增量成本效果比（ICER）低于人均GDP的1-3倍，则认为干预措施具有成本效益。例如，基于重力的预防母婴传播的风险系数为109美元/天。在免疫诊所进行同伴提供的自我检测和孕产妇艾滋病毒筛查显示出较强的经济效益。很少有研究纳入了关于药物依从性、退出或服务交付成本的真实数据。结论：有针对性的综合艾滋病毒预防策略在SSA具有成本效益。今后的研究应改进经验依从性和执行数据的使用，并将重点扩大到代表性不足的人口和区域。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Expert Review of Pharmacoeconomics & Outcomes Research HEALTH CARE SCIENCES & SERVICES-PHARMACOLOGY & PHARMACY

CiteScore

4.00

自引率

4.30%

发文量

审稿时长

6-12 weeks

期刊介绍： Expert Review of Pharmacoeconomics & Outcomes Research (ISSN 1473-7167) provides expert reviews on cost-benefit and pharmacoeconomic issues relating to the clinical use of drugs and therapeutic approaches. Coverage includes pharmacoeconomics and quality-of-life research, therapeutic outcomes, evidence-based medicine and cost-benefit research. All articles are subject to rigorous peer-review. The journal adopts the unique Expert Review article format, offering a complete overview of current thinking in a key technology area, research or clinical practice, augmented by the following sections: Expert Opinion – a personal view of the data presented in the article, a discussion on the developments that are likely to be important in the future, and the avenues of research likely to become exciting as further studies yield more detailed results Article Highlights – an executive summary of the author’s most critical points.