Cost-effectiveness of eHealth-based HIV pre-exposure intervention for recreational drugs using among men who have sex with men in China: a modelling study.

Background: Recreational drug (RD) is widespread among men who have sex with men (MSM), inspiring "Chemsex" which then exacerbates the spread of HIV. Electronic health (eHealth) can effectively intervene in RD use, while the efficacy of oral pre-exposure prophylaxis (PrEP) in HIV prevention has been well-documented. However, eHealth and PrEP have not been implemented on a large-scale in China, and the cost-effectiveness of intervention remains uncertain. This study conducted a dynamic modelling to predict HIV prevalence trends among MSM and the cost-effectiveness of various interventions.

Methods: Through constructing the HIV-RD model, HIV trends among MSM for the next 30 years are projected. Social network intervention and customized short message service (SMS) in eHealth were combined with PrEP to form 9 intervention scenarios: status quo; social network intervention; SMS; 30%PrEP; 70%PrEP; social network intervention with 30%PrEP; social network intervention with 70%PrEP; SMS with 30%PrEP; SMS with 70%PrEP. The cost-effectiveness of each scenario was evaluated economically, and the results were presented as incremental cost-effectiveness ratio (ICER).

Findings: Implementing interventions would prevent 57,937-142,892 HIV infections and 24,091-61,680 deaths. From societal perspective, all interventions' ICERs were from $11,669 to $29,806. Social network intervention was advantageous, saving about $1.97 billion while gaining 169,354 quality-adjusted life years (QALYs). SMS, social network intervention with 30% PrEP were highly cost-effective, with ICERs of $5,869 and $20,325. Sensitivity analysis found that PrEP's costs had the most significant impact.

Conclusions: In China, implementing eHealth, expanding PrEP, and joint interventions for MSM are cost-effective. Considering funding, social network intervention could be prioritized.