Cost-effectiveness of HIV pre-exposure prophylaxis among people who inject drugs in Iran: an economic evaluation study

The Iranian government does not fund HIV pre-exposure prophylaxis (PrEP), and PrEP is infrequently used in Iran, in part due to uncertainties about its cost-effectiveness, stigma, and lack of education. In this study, we assessed the cost-effectiveness of PrEP among Iranian people who inject drugs (PWID). The cost-effectiveness analysis compared PrEP-alone, a combination of PrEP with harm reduction (HR), and an HR-alone strategy among PWID over a 10-year time horizon. For the cost analysis, we considered the healthcare program development perspective. The primary outcome was disability-adjusted life years (DALYs) averted. Analyses included costs and health outcomes, as well as the incremental cost-effectiveness ratio (ICER), which was reported as the cost per DALYs averted. The PrEP-alone strategy, found to be dominated with an ICER of USD − 572.65 per DALY averted, was not cost-effective at a willingness-to-pay threshold of USD 4669.60 per DALY averted in Iran. In contrast, combining PrEP with HR was cost-effective at the same willingness-to-pay threshold. The ICER was USD 1,153.86 per DALYs averted for combining PrEP with HR compared to HR alone. The combination of PrEP with HR was a cost-effective strategy 76.3% of the time. Compared to HR, combining PrEP with HR is a cost-effective intervention among Iranian PWID for reducing the economic burden and improving health outcomes associated with HIV over a 10-year time horizon. Iran should add PrEP to its current HR programs for PWID.