Abstract / Summary
Introduction Pre-Exposure Prophylaxis (PrEP) is a highly effective intervention for HIV prevention, yet its economic viability across diverse Asian settings, particularly among men who have sex with men (MSM), remains variable. This systematic review aimed to synthesize evidence regarding the cost-effectiveness of various PrEP formulations and delivery strategies for MSM in Asia. Methodology This systematic review was reported in accordance with the PRISMA 2020 guidelines. The PICO framework was used to define the review scope, focusing on studies evaluating PrEP formulations among MSM populations in Asian countries that reported at least one economic outcome and were published in English from 2015 onwards. A literature search was performed across three databases: PubMed, ScienceDirect, and Scopus. The quality of included studies was assessed using the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) checklist. Data were extracted into summary tables and synthesized narratively. Results A total of 12 full economic evaluations were included in the final review, originating from China, Thailand, India, South Korea, and Japan. Most studies employed Cost-Effectiveness Analysis (CEA) or Cost-Utility Analysis (CUA), predominantly using modelling approaches from a provider perspective. Overall, targeted PrEP strategies, lower-cost generic regimens, and community-led delivery models were generally found to be more cost-effective than universal or high-cost approaches. The quality appraisal demonstrated moderate-to-high reporting quality across core methodological domains, although reporting of heterogeneity, distributional effects, and stakeholder engagement remained limited. Conclusion PrEP appears cost-effective in several Asian settings for HIV prevention among MSM, although its economic value varies according to program design, drug costs, and local epidemiological conditions. Policymakers may consider prioritizing affordable generic regimens, community-led service delivery models, and targeted implementation strategies to improve cost-effectiveness and program sustainability. Future research should focus on bridging the gap between modelling studies and real-world evidence to better inform long-term financing and implementation decisions.