China faces a growing HIV burden among men who have sex with men (MSM), yet uptake of pre-exposure prophylaxis (PrEP) remains low. Long-acting injectable cabotegravir (CAB-LA) may improve prevention effectiveness, but its economic value in China remains uncertain. We developed a risk-stratified dynamic compartmental model incorporating HIV natural history, diagnosis, ART, and both transmitted and acquired drug resistance. Model parameters were calibrated to published surveillance data in Zhejiang and Jiangsu Province from 2009 to 2019. Assuming zero PrEP coverage in 2025, we simulated scale-up among high-risk MSM through 2030 under six scenarios: no PrEP (status quo) ; 20%, 50%, and 80% oral PrEP only; and total PrEP coverage of 80% with CAB-LA comprising 20% or 50% of PrEP use. Outcomes were projected to 2050, including epidemic trend and PrEP cost-effectiveness presented as incremental cost-effectiveness ratio (ICER). Across Zhejiang and Jiangsu, expanding PrEP in high-risk MSM substantially reduced cumulative HIV infections, drug-resistant infections, and HIV-related deaths during 2025–2050. Oral PrEP-only strategies were cost-effective in Zhejiang (ICER US45, 961–55, 053 per QALY for 20%–80% coverage) and highly cost-effective in Jiangsu (US11, 699–12, 762 per QALY). At 80% total PrEP coverage, incorporating CAB-LA markedly increased ICERs and remained cost-effective only in Jiangsu under 80% PrEP (20% CAB-LA) (US56, 980 per QALY). In Zhejiang, CAB-LA would require an approximately 91% price reduction to potentially achieve cost-effectiveness. Expanding oral PrEP among low-risk MSM is not cost-effective or is only marginally cost-effective. Risk-targeted scale-up of oral PrEP among high-risk MSM is an efficient near-term strategy in eastern China. Wider CAB-LA implementation is unlikely to be cost-effective at current prices and will likely require substantial price reductions.
Zhu et al. (Thu,) studied this question.