ArticleJournal of the International AIDS Society2025
Epidemiological impact and cost-effectiveness analysis of PrEP provision expansion among MSM in the Netherlands.
Article in Journal of the International AIDS Society, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 8 papers, 3 of them syntheses that pooled it.
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Who cites it
8 citing papers in PubMed, 3 syntheses or guidelines pooled it.
- Prospects of HIV elimination among men who have sex with men: A systematic review of modeling studies.PLoS computational biology · 2026Pooled it
- Interest in and Preference for Long-Acting Injectable Pre-exposure Prophylaxis Among Men Who Have Sex With Men, Trans* Individuals, and Cisgender Heterosexual Women: A Global Systematic Review and Meta-Analysis.Journal of acquired immune deficiency syndromes (1999) · 2025Pooled it
- Evolving landscape of economic evaluations of HIV pre-exposure prophylaxis and pre-exposure prophylaxis implementation strategies: a systematic review.Journal of the International AIDS Society · 2025Pooled it
- Epidemiologic Impact of Prioritizing Long-Acting Injectable Cabotegravir to Men Who Have Sex With Men With Low Pre-Exposure Prophylaxis Use Adherence in the Netherlands: A Mathematical Modeling Study.Journal of acquired immune deficiency syndromes (1999) · 2026Article
- Exploring the Interest and Intention to Use Long-Acting Injectable PrEP (LAI-PrEP) Among Gay, Bisexual and Other Men Who Have Sex with Men (GBMSM) in the Netherlands.AIDS and behavior · 2026Article
- The unseen impact of affordability: copayment sensitivity for long-acting PrEP among MSM in six European Countries, October 2023-April 2024.Scientific reports · 2025Article
- Perceptions of Long-Acting Injectable Pre-Exposure Prophylaxis Among Men Who Have Sex With Men and Transgender Individuals in Europe Using Structural Text Modeling Technique: Cross-Sectional Study.JMIR public health and surveillance · 2025Article
- Oral PrEP use and intention to use long-acting PrEP regimens among MSM accessing PrEP via governmental and non-governmental provision pathways, 20 European countries, October 2023 to April 2024.Euro surveillance : bulletin Europeen sur les maladies transmissibles = European communicable disease bulletin · 2025Article
Corrections and comments
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Authors and funding
4 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
introductionSeveral European countries show potential for pre-exposure prophylaxis (PrEP) provision expansion, with many men who have sex with men (MSM) on waiting lists. In the Netherlands, approximately 15,000 PrEP-eligible/intending MSM are awaiting PrEP access. We modelled the epidemiological and economic impact of extending PrEP provision considering several PrEP provision routes (National PrEP Programme and alternative PrEP providers).
methodsWe calibrated our HIV transmission model among the Dutch MSM epidemic. PrEP was expanded from 2022 onwards, covering an additional 3000 MSM on the waiting list and in addition one-third (5000), two-thirds (10,000), and all (15,000) PrEP-eligible/intending MSM by 2024, compared to a non-expansion scenario. The epidemiological impact was projected by 2030. Costs were calculated from a third-party payer's perspective over 40 years with Dutch-specific quality-adjusted life years (QALY). Additionally, a budget impact analysis was performed over 5 years.
resultsCovering the 3000 waiting-list MSM, one-third, two-thirds and all PrEP eligible/intending MSM by 2024 will avert 17 (5.7%), 46 (15.2%), 88 (29.1%) and 115 (37.9%) cumulative new HIV acquisitions compared to the base-case scenario. Consequently, 4, 2, 0 and 0 new HIV acquisitions will result by 2030, respectively. The epidemiological impact of PrEP expansion is sensitive to the users' PrEP adherence, but overall minimal by PrEP targeting strategies, given the strongly declining epidemic. Increasing the National PrEP Programme's capacity incurred more costs to the payer (short-term budget impact ranging from €2.25 to €45.29 million). PrEP expansion can be cost-saving when all PrEP-eligible/intending MSM are covered and fully provided by alternative PrEP providers, with an incremental cost-effectiveness ratio of -€2160/QALY over 40 years. This scenario dominated over all other scenarios. Our cost-effectiveness analysis is most sensitive to the individual co-payment for PrEP-related testing when accessing PrEP via alternative PrEP providers and on-demand PrEP use.
conclusionsExpanding PrEP coverage is crucial to reduce HIV acquisitions further and reach zero new acquisitions by 2030. As the Dutch National PrEP Programme reached capacity limits, PrEP expansion through alternative routes should be encouraged. Nevertheless, balancing out-of-pocket expenses and reimbursed care is key for healthcare equity.
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