Economic evaluation of short message service intervention for HIV prevention among men who have sex with men in China: a modelling study

Abstract

Background

Men who have sex with men (MSM) globally face a high risk of HIV infection. Previous studies indicate that customized short message service (SMS) interventions could reduce high-risk behaviors that associated with HIV transmission. This study aims to evaluate the health and economic impacts of such interventions among MSM in China.

Methods

A decision tree-Markov model was developed for a simulated cohort of 100,000 MSM of 20 years old. We assessed three intervention strategies: (1) routine strategy with standard health information; (2) SMS strategy with customized messages based on individual high-risk behaviors, with 50.1% efficacy and 50% coverage; (3) LEN-LA (lenacapavir long-acting) strategy as pre-exposure prophylaxis (PrEP), with 100% efficacy lasting for 0.5-year and 50% coverage. The study period was 45 years. Primary outcomes included the number of HIV infections and HIV-related deaths. The cost-effectiveness, cost-utility and cost-benefit analyses were conducted along with sensitivity analyses from the healthcare sector perspective.

Results

The SMS strategy was more effective, averting 6,191 (22.0%) HIV infections and 2,100 (38.5%) HIV-related deaths when compared with routine strategy. The average cost-effectiveness ratios (ACERs) were US$6,361 (95% CI: 5,959-6,613) per HIV infection averted and US$18,752 (95% CI: 17,274 − 20,530) per HIV-related death averted. It had incremental cost-effectiveness ratios (ICERs) of US$1,743 (95% CI: 1,673-1,799) per QALY, with a benefit cost ratio (BCR) of 1.98 (95% CI: 1.94–2.02), compared with routine strategy. While the LEN-LA strategy may be the most effective, its high cost, coupled with the highest ICER, currently presents a considerable obstacle to its widespread adoption. The ICERs were most affected by the probability of HIV infection, intervention cost and coverage.

Conclusions

SMS strategy for preventing HIV among MSM in China is cost-effective and could be a promising strategy for HIV prevention. These findings may have implications for public health policy and resource allocation in HIV prevention efforts targeting high-risk populations.