Despite proven oral pre-exposure prophylaxis (PrEP) efficacy, adherence barriers among men who have sex with men (MSM) persist. Economic viability of digital adherence tools in low- and middle-income countries (LMICs) requires validation. We assessed the 6-month within-trial cost-effectiveness of a digital intervention for real-time enhancement of oral PrEP adherence (DIRECT-PrEP) in China, from health system, multipayer, and societal perspectives. Costs were derived from hospital records, and effectiveness was evaluated using quality-adjusted life-years (QALYs) and PrEP-adherence days (PADs). Among 442 participants (247 intervention, 195 standard care), incremental costs per QALY gained for the smart pillbox intervention were 19, 575. 93 (health system), 19, 656. 66 (multipayer), and 19, 844. 42 (societal) -all below the cost-effectiveness threshold of three times per capita gross domestic product (31, 200). Costs per PAD gained were 30. 46-30. 86, achieving >95% probability of cost-effectiveness at willingness-to-pay thresholds of 47. 50-48. 50 per PAD. Notably, the intervention demonstrated greater cost-effectiveness per QALY among participants stratified as more socially vulnerable (16, 259. 77-16, 490. 41) compared with those classified as less socially vulnerable (23, 514. 83-23, 834. 38). These results establish the smart-pillbox digital intervention as a cost-effective strategy for oral PrEP adherence within primary healthcare settings in LMICs, particularly when prioritizing more socially vulnerable populations, though long-term scalability requires further validation.
Wu et al. (Wed,) studied this question.