Epidemiology and Social: CONCISE COMMUNICATIONSOffering a choice of daily and event-driven preexposure prophylaxis for men who have sex with men in the Netherlands: a cost-effectiveness analysisvan Hoek, Albert Jana; Reitsema, Maartena,b; Xiridou, Mariaa; van Sighem, Ardc; van Benthem, Birgita; Wallinga, Jaccoa,b; van Duijnhoven, Yvonned; van der Loeff, Maarten Schimd,e; Prins, Mariad,e; Hoornenborg, Elsked,f; on behalf of the Amsterdam PrEP Project Team in the HIV Transmission Elimination Amsterdam (H-TEAM) InitiativeAuthor Information aDepartment of Epidemiology and Surveillance, National Institute for Public Health and Environment, Bilthoven bDepartment of Biomedical Data Sciences, Leiden University Medical Center, Leiden cStichting HIV Monitoring dDepartment of Infectious Diseases, Public Health Service Amsterdam eDepartment of Infectious Diseases, Amsterdam Infection and Immunity Institute (AIII), Amsterdam University Medical Centres fDepartment of Infectious Diseases, STI Outpatient Clinic, Public Health Service Amsterdam, Amsterdam, The Netherlands. Correspondence to Maria Xiridou, National Institute of Public Health and the Environment, PO Box 1, 3720 BA Bilthoven, The Netherlands. Tel: +31 30 2748547; fax: +31 30 2743057; e-mail: [email protected] Received 12 October, 2020 Revised 10 March, 2021 Accepted 14 March, 2021 Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Website (http://www.AIDSonline.com). AIDS: August 1, 2021 - Volume 35 - Issue 10 - p 1677-1682 doi: 10.1097/QAD.0000000000002913 Buy SDC Metrics Abstract Objectives: To assess the cost-effectiveness of a preexposure prophylaxis (PrEP) programme offering a choice of daily and event-driven PrEP for men who have sex with men (MSM) in the Netherlands. Methods: We used an agent-based transmission model and an economic model to simulate a programme offering only daily PrEP and a programme offering daily and event-driven PrEP. Use of PrEP medication and preference for daily versus event-driven PrEP were estimated from the Amsterdam PrEP Demonstration Project (AMPrEP). We calculated costs, quality-adjusted life-years (QALY), and incremental cost-effectiveness ratios (ICER), over 2018–2027. An ICER less than €20 000 per QALY gained was considered cost-effective. Results: Using AMPrEP data, we estimated that 27% of PrEP users chose event-driven PrEP with a median of 12 pills per month; daily PrEP users used a median of 30 pills per month. With PrEP, 3740 HIV infections were averted and 1482 QALYs were gained over 2018–2027, compared to the scenario without PrEP. The probability of the PrEP programme being cost-effective (compared to not having a PrEP programme) increased from 91% with daily PrEP to 94% with a choice of daily and event-driven PrEP. The probability of being cost-saving increased from 42% with only daily PrEP to 48% with choice of daily and event-driven PrEP. Conclusions: A daily PrEP programme for MSM would be cost-effective. Providing a choice of daily and event-driven PrEP can result in savings and is more likely to be cost-effective and cost-saving, compared to a programme offering only daily PrEP. Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.