Date of Award

January 2026

Document Type

Open Access Thesis

Degree Name

Master of Public Health (MPH)

Department

School of Public Health

First Advisor

Onyema Ogbuagu

Second Advisor

David Paltiel

Abstract

Men who have sex with men (MSM) remain a key at-risk population in China’s HIV epidemic while the real-world effectiveness of daily oral pre-exposure prophylaxis (PrEP) among MSM has been limited by low uptake and suboptimal drug adherence. Lenacapavir, a first-in-class capsid inhibitor administered twice yearly, emerged as a highly efficacious, long-acting prevention strategy with the potential to reduce drug burdens associated with current PrEP strategy. However, its high price ($28,000 per patient per year) raises major affordability concerns, and its economic value in China remains understudied. This study aimed to evaluate the cost-effectiveness of lenacapavir compared with daily oral PrEP (TDF/FTC) for HIV prevention among MSM in China from the healthcare payer perspective.

A state-transition Markov model was developed in Microsoft Excel and R to assess the cost-effectiveness of two different PrEP strategies over a life-time horizon. A hypothetical cohort of 100,000 HIV-negative MSM entered the model and was followed on a monthly cycle. Costs and quality-adjusted life-years (QALYs) were discounted at 3% annually. The primary outcome was the incremental cost-effectiveness ratio (ICER). Deterministic one-way sensitivity analysis and a price-threshold analysis were performed to examine uncertainty and maximum price.

Compared to TDF/FTC, lenacapavir produced higher discounted lifetime costs (¥574,121/person), greater health benefits (QALYs 24.03/person), and averted 1,818 additional HIV infections. This yielded an ICER of ¥5,902,465 per QALY gained. Sensitivity analyses showed that the model was most sensitive to lenacapavir dose cost, and the price-threshold analysis estimated that the maximum price for lenacapavir to be cost effective was approximately $476.47 per dose (¥3,403.38).

In the context of preventing HIV infection among MSM in China, lenacapavir was not cost-effective as compared to TDF/FTC given its current price.

Comments

This is an Open Access Thesis.

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