{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T15:46:34Z","timestamp":1791215194969,"version":"4.1.0"},"reference-count":40,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2025,6,3]],"date-time":"2025-06-03T00:00:00Z","timestamp":1748908800000},"content-version":"vor","delay-in-days":2,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J Int AIDS Soc."],"published-print":{"date-parts":[[2025,6]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Introduction<\/jats:title><jats:p>Several European countries show potential for pre\u2010exposure prophylaxis (PrEP) provision expansion, with many men who have sex with men (MSM) on waiting lists. In the Netherlands, approximately 15,000 PrEP\u2010eligible\/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).<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We 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\u2010third (5000), two\u2010thirds (10,000), and all (15,000) PrEP\u2010eligible\/intending MSM by 2024, compared to a non\u2010expansion scenario. The epidemiological impact was projected by 2030. Costs were calculated from a third\u2010party payer's perspective over 40 years with Dutch\u2010specific quality\u2010adjusted life years (QALY). Additionally, a budget impact analysis was performed over 5 years.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Covering the 3000 waiting\u2010list MSM, one\u2010third, two\u2010thirds 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\u2010case 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\u2019 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\u2010term budget impact ranging from \u20ac2.25 to \u20ac45.29 million). PrEP expansion can be cost\u2010saving when all PrEP\u2010eligible\/intending MSM are covered and fully provided by alternative PrEP providers, with an incremental cost\u2010effectiveness ratio of \u2212\u20ac2160\/QALY over 40 years. This scenario dominated over all other scenarios. Our cost\u2010effectiveness analysis is most sensitive to the individual co\u2010payment for PrEP\u2010related testing when accessing PrEP via alternative PrEP providers and on\u2010demand PrEP use.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Expanding 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\u2010of\u2010pocket expenses and reimbursed care is key for healthcare equity.<\/jats:p><\/jats:sec>","DOI":"10.1002\/jia2.26516","type":"journal-article","created":{"date-parts":[[2025,6,4]],"date-time":"2025-06-04T06:19:36Z","timestamp":1749017976000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":11,"title":["Epidemiological impact and cost\u2010effectiveness analysis of PrEP provision expansion among MSM in the Netherlands"],"prefix":"10.1002","volume":"28","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1844-7156","authenticated-orcid":false,"given":"Haoyi","family":"Wang","sequence":"first","affiliation":[{"name":"Department of Work and Social Psychology Maastricht University  Maastricht The Netherlands"},{"name":"Viroscience Department Erasmus Medical Centre  Rotterdam The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephanie","family":"Popping","sequence":"additional","affiliation":[{"name":"Department of Medical Microbiology and Infection Prevention Amsterdam University Medical Center, University of Amsterdam  Rotterdam The Netherlands"},{"name":"Cener for Infection and Molecular Medicine (CIMM) Amsterdam University Medical Center  Amsterdam The Netherlands"},{"name":"Amsterdam Institute for Immunology and Infectious Diseases  Amsterdam The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5877-8526","authenticated-orcid":false,"given":"David","family":"van de Vijver","sequence":"additional","affiliation":[{"name":"Viroscience Department Erasmus Medical Centre  Rotterdam The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6607-1993","authenticated-orcid":false,"given":"Kai J.","family":"Jonas","sequence":"additional","affiliation":[{"name":"Department of Work and Social Psychology Maastricht University  Maastricht The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,6,3]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1011205"},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1506273"},{"key":"e_1_2_11_4_1","unstructured":"vanSighemAI WitF BoydA SmitC MatserA ReissP. Monitoring Report 2023.Human Immunodeficiency Virus (HIV) Infection in the Netherlands.Amsterdam:Stitching HIV Monitoring;2022."},{"issue":"40","key":"e_1_2_11_5_1","article-title":"A 95% decline in estimated newly acquired HIV infections, Amsterdam, 2010 to 2022","volume":"28","author":"The HIV Transmission Elimination AMsterdam Initiative","year":"2023","journal-title":"Euro Surveill"},{"key":"e_1_2_11_6_1","unstructured":"BiermanW HoornenborgE NellenJ.Nederlandse multidisciplinaire richtlijn Pre\u2010expositie profylaxe (PrEP) ter preventie van hiv (update 2022).2022. [cited 2025 May 20]. Available from:https:\/\/www.soaaids.nl\/files\/2022\u201007\/20220711\u2010PrEP\u2010richtlijn\u2010Nederland\u2010versie\u20103\u2010update\u20102022.pdf."},{"key":"e_1_2_11_7_1","unstructured":"National Institute for Public Health and the Environment.Aantal PrEP gebruikers per GGD binnen regeling PrEP: Overzicht per eind februari 2023.2023."},{"key":"e_1_2_11_8_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10461-020-03085-9"},{"key":"e_1_2_11_9_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10461-021-03200-4"},{"key":"e_1_2_11_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2352-3018(23)00009-7"},{"key":"e_1_2_11_11_1","first-page":"17","article-title":"Differences in oral PrEP use patterns and intention to use long\u2010acting regimens among MSM between formal and informal PrEP provision pathways in 20 European countries: a latent class analysis","volume":"27","author":"Wang H","year":"2024","journal-title":"J Int AIDS Soc"},{"key":"e_1_2_11_12_1","unstructured":"NOS.Kabinet breidt vanaf volgende zomer toegang tot hiv\u2010preventiepil uit.2023. [cited 2025 May 20]. Available from:https:\/\/nos.nl\/artikel\/2491841\u2010kabinet\u2010breidt\u2010vanaf\u2010volgende\u2010zomer\u2010toegang\u2010tot\u2010hiv\u2010preventiepil\u2010uit."},{"key":"e_1_2_11_13_1","unstructured":"CBS.Inflation rate 10.0 percent in 2022.2023. [cited 2025 May 20]. Available from:https:\/\/www.cbs.nl\/en\u2010gb\/news\/2023\/02\/inflation\u2010rate\u201010\u20100\u2010percent\u2010in\u20102022#:~:text=Based%20on%20the%20HICP%2C%20prices ent%20in%202021%20to%208."},{"key":"e_1_2_11_14_1","doi-asserted-by":"publisher","DOI":"10.3390\/ijerph19148829"},{"key":"e_1_2_11_15_1","doi-asserted-by":"publisher","DOI":"10.1007\/s13178-019-00413-0"},{"key":"e_1_2_11_16_1","doi-asserted-by":"publisher","DOI":"10.1002\/jia2.26089"},{"issue":"7","key":"e_1_2_11_17_1","article-title":"Cost\u2010effectiveness and budget effect of pre\u2010exposure prophylaxis for HIV\u20101 prevention in Germany from 2018 to 2058","volume":"24","author":"Vijver D","year":"2019","journal-title":"Euro Surveill"},{"key":"e_1_2_11_18_1","doi-asserted-by":"publisher","DOI":"10.1002\/jia2.26109"},{"key":"e_1_2_11_19_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2468-2667(22)00106-2"},{"key":"e_1_2_11_20_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.lanepe.2021.100177"},{"key":"e_1_2_11_21_1","unstructured":"Nederlandse Zorg Autoriteit.TARIEVEN LABORATORIUM MEDISCHE MICROBIOLOGIE VANAF 1 januari 2022* 2022. [cited 2025 May 20]. Available from:https:\/\/www.scal.nl\/system\/files\/inline\/Prijzen%20website%20online%20MM%202022.pdf."},{"key":"e_1_2_11_22_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0280877"},{"key":"e_1_2_11_23_1","doi-asserted-by":"publisher","DOI":"10.1007\/s40273-020-00942-2"},{"key":"e_1_2_11_24_1","doi-asserted-by":"publisher","DOI":"10.1080\/09540121.2024.2307378"},{"key":"e_1_2_11_25_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2352-3018(17)30089-9"},{"key":"e_1_2_11_26_1","doi-asserted-by":"publisher","DOI":"10.1097\/QAD.0000000000001658"},{"key":"e_1_2_11_27_1","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2458-13-919"},{"key":"e_1_2_11_28_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.sste.2023.100577"},{"key":"e_1_2_11_29_1","doi-asserted-by":"publisher","DOI":"10.2807\/1560-7917.ES.2024.29.48.2400778"},{"key":"e_1_2_11_30_1","doi-asserted-by":"publisher","DOI":"10.2807\/1560-7917.ES.2024.29.48.2400347"},{"key":"e_1_2_11_31_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0260063"},{"key":"e_1_2_11_32_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1473-3099(16)30311-5"},{"key":"e_1_2_11_33_1","doi-asserted-by":"publisher","DOI":"10.1097\/QAI.0000000000003511"},{"key":"e_1_2_11_34_1","doi-asserted-by":"publisher","DOI":"10.1089\/apc.2014.0226"},{"key":"e_1_2_11_35_1","doi-asserted-by":"publisher","DOI":"10.3389\/fpubh.2023.1196958"},{"key":"e_1_2_11_36_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.lanepe.2022.100486"},{"key":"e_1_2_11_37_1","unstructured":"UNAIDS.End Inequalities. End AIDS. Global AIDS Strategy 2021\u20132026.2021. [cited 2025 May 20]. Available from:https:\/\/www.unaids.org\/en\/resources\/documents\/2021\/2021\u20102026\u2010global\u2010AIDS\u2010strategy."},{"key":"e_1_2_11_38_1","unstructured":"KayaertL SarinkD VisserM vanWeesDA WillemsteinIJM Op de CoulELM et\u00a0al.Sexually transmitted infections in the Netherlands in 2022.2023. [cited 2025 May 20]. Available from:https:\/\/www.soaaids.nl\/files\/2023\u201006\/75790_23401268_RIVM_014630_rap_2023\u20100161_SOA_jaarrapport_v4.pdf."},{"key":"e_1_2_11_39_1","unstructured":"World Health Organization.WHO recommends optimizing HIV testing services.2023. [cited 2025 May 20]. Available from:https:\/\/www.who.int\/news\/item\/22\u201007\u20102023\u2010who\u2010recommends\u2010optimizing\u2010hiv\u2010testing\u2010services."},{"key":"e_1_2_11_40_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2352-3018(22)00126-6"},{"key":"e_1_2_11_41_1","doi-asserted-by":"publisher","DOI":"10.1097\/QAD.0000000000003271"}],"container-title":["Journal of the International AIDS Society"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/jia2.26516","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,6,25]],"date-time":"2025-06-25T10:23:09Z","timestamp":1750846989000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/jia2.26516"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,6]]},"references-count":40,"journal-issue":{"issue":"6","published-print":{"date-parts":[[2025,6]]}},"alternative-id":["10.1002\/jia2.26516"],"URL":"https:\/\/doi.org\/10.1002\/jia2.26516","archive":["Portico"],"relation":{},"ISSN":["1758-2652","1758-2652"],"issn-type":[{"value":"1758-2652","type":"print"},{"value":"1758-2652","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,6]]},"assertion":[{"value":"2024-03-29","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-05-20","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-06-03","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e26516"}}