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. 2025 Mar 5;15(1):7747.
doi: 10.1038/s41598-025-92099-1.

Cost-effectiveness of HIV pre-exposure prophylaxis among female sex workers in Iran

Hossein Moameri  1 , Reza Goudarzi  2 , Ali Akbar Haghdoost  3 , Mohammad Mehdi Gouya  4 , Parya Saberi  5 , Ali Mirzazadeh  6 , Parvin Mangolian Shahrbabaki  7 , Hamid Sharifi  8   9
Affiliations

Cost-effectiveness of HIV pre-exposure prophylaxis among female sex workers in Iran

Hossein Moameri et al. Sci Rep. .

Abstract

The Iranian government does not fund pre-exposure prophylaxis (PrEP), and it is not used in Iran due to uncertainties in its cost-effectiveness. In this study, we examined the cost-effectiveness of PrEP among female sex workers (FSWs) in Iran. The cost-effectiveness analysis compared only PrEP, a combination of PrEP with harm reduction (HR) with only HR scenario among FSWs over a 10-year time horizon. The perspective of the healthcare provider was used in the analysis. The primary outcome was disability-adjusted life year (DALY) averted. Analyses included health and cost outcomes, as well as the incremental cost-effectiveness ratio (ICER), which was reported as the cost per DALY averted. Only PrEP was not cost-effective at a willingness to pay threshold of 4669.6 USD per DALY averted in Iran. In contrast, PrEP and HR strategies were cost-effective at the same willingness to pay threshold. The ICER was 868.47 USD per DALY averted for PrEP and HR compared to HR alone. Compared to HR, combining PrEP with HR is a cost-effective intervention among Iranian FSWs for reducing the clinical and economic burden associated with HIV over a 10-year time horizon. Iran should add PrEP to current HR programs for FSWs.

Keywords: Cost-effectiveness analysis; HIV infections; Harm reduction; Iran; Pre-exposure prophylaxis; Sex workers.

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Conflict of interest statement

Declarations. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Decision analytical model structure comparing PrEP, PrEP + HR with HR in 1,000 female sex workers at high HIV risk, Iran, 2023.
Fig. 2
Fig. 2
One-way sensitivity analyses. The tornado diagram displays the sensitivity of the incremental cost-effectiveness ratio (ICER) of PrEP + HR compared to HR to variation in a large number of input parameter values (Chart A includes costs and inflation rates, and Chart B includes DALYs, effects, and probabilities).
Fig. 3
Fig. 3
Cost-effectiveness (quality-adjusted life-years versus total costs over 10 years) of 76% scale-up for single or combination programs.
Fig. 4
Fig. 4
Incremental cost-effectiveness, PrEP + HR, versus HR. Each dot represents an individual simulation of the Monte Carlo analysis. The x-axis represents the additional DALY averted per FSW (across all risk groups). The Y-axis represents the incremental cost per FSW (across all risk groups).
Fig. 5
Fig. 5
Cost-effectiveness acceptability curve. The cost-effectiveness of PrEP availability for three interventions, PrEP, PrEP + HR, and HR for female sex workers, was assessed through a Monte Carlo simulation. = Willingness to pay (WTP) – US$4669.6/ DALY averted.
See this image and copyright information in PMC

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