To assess the impact of a pre-exposure prophylaxis
) programme for high-risk men who have sex with men
(MSM), which includes gonorrhoea
testing and treatment, on the transmission of HIV
and N. gonorrhoeae
among MSM in the Netherlands and the cost-effectiveness
of such programme with and without risk compensation (in the form of reduced condom use).
We developed a stochastic agent-based transmission model
. We simulated a capped (max 2.5% of MSM) and uncapped (5.5% of MSM in 2018 declining to 3% in 2027) daily PrEP
programme for high-risk MSM, with three-monthly HIV
testing, with and without risk compensation. Epidemiological outcomes were calculated from the transmission model
and used in an economic model to calculate costs, quality-adjusted life-years (QALY), and incremental cost-effectiveness
ratios (ICER), over 2018–2027, taking a healthcare payer perspective.
Without risk compensation, PrEP
can lead to a reduction of 61% or 49% in the total number of new HIV
infections in 2018–2027, if the programme is uncapped or capped to 2.5% of MSM, respectively. With risk compensation, this reduction can be 63% or 46% in the uncapped and capped programmes, respectively. In all scenarios, gonorrhoea
prevalence decreased after introducing PrEP
. Without risk compensation, 92% of simulations were cost-effective (of which 52% cost-saving). With risk compensation, 73% of simulations were cost-effective (of which 23% was cost-saving).
A nationwide PrEP
programme for high-risk MSM can result in substantial reductions in HIV
transmission and be cost-effective, even with risk compensation.