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- Title
Healthcare Costs and Life-years Gained From Treatments Within the Advancing Cryptococcal Meningitis Treatment for Africa (ACTA) Trial on Cryptococcal Meningitis: A Comparison of Antifungal Induction Strategies in Sub-Saharan Africa.
- Authors
Chen, Tao; Mwenge, Lawrence; Lakhi, Shabir; Chanda, Duncan; Mwaba, Peter; Molloy, Síle F; Gheorghe, Adrian; Griffiths, Ulla K; Heyderman, Robert S; Kanyama, Cecilia; Kouanfack, Charles; Mfinanga, Sayoki; Chan, Adrienne K; Temfack, Elvis; Kivuyo, Sokoine; Hosseinipour, Mina C; Lortholary, Olivier; Loyse, Angela; Jaffar, Shabbar; Harrison, Thomas S
- Abstract
Background Mortality from cryptoccocal meningitis remains high. The ACTA trial demonstrated that, compared with 2 weeks of amphotericin B (AmB) plus flucystosine (5FC), 1 week of AmB and 5FC was associated with lower mortality and 2 weeks of oral flucanozole (FLU) plus 5FC was non-inferior. Here, we assess the cost-effectiveness of these different treatment courses. Methods Participants were randomized in a ratio of 2:1:1:1:1 to 2 weeks of oral 5FC and FLU, 1 week of AmB and FLU, 1 week of AmB and 5FC, 2 weeks of AmB and FLU, or 2 weeks of AmB and 5FC in Malawi, Zambia, Cameroon, and Tanzania. Data on individual resource use and health outcomes were collected. Cost-effectiveness was measured as incremental costs per life-year saved, and non-parametric bootstrapping was done. Results Total costs per patient were US $1442 for 2 weeks of oral FLU and 5FC, $1763 for 1 week of AmB and FLU, $1861 for 1 week of AmB and 5FC, $2125 for 2 weeks of AmB and FLU, and $2285 for 2 weeks of AmB and 5FC. Compared to 2 weeks of AmB and 5FC, 1 week of AmB and 5FC was less costly and more effective and 2 weeks of oral FLU and 5FC was less costly and as effective. The incremental cost-effectiveness ratio for 1 week of AmB and 5FC versus oral FLU and 5FC was US $208 (95% confidence interval $91–1210) per life-year saved. Clinical Trials Registration ISRCTN45035509. Conclusions Both 1 week of AmB and 5FC and 2 weeks of Oral FLU and 5FC are cost-effective treatments.
- Subjects
CAMEROON; MALAWI; TANZANIA; ZAMBIA; SUB-Saharan Africa; AMPHOTERICIN B; ANTIFUNGAL agents; COMBINATION drug therapy; COMPARATIVE studies; CONFIDENCE intervals; COST effectiveness; CRYPTOCOCCUS neoformans; ECONOMIC aspects of diseases; MEDICAL care costs; MENINGITIS; NONPARAMETRIC statistics; ORAL drug administration; QUALITY of life; TREATMENT effectiveness; TREATMENT duration; THERAPEUTICS
- Publication
Clinical Infectious Diseases, 2019, Vol 69, Issue 4, p588
- ISSN
1058-4838
- Publication type
Article
- DOI
10.1093/cid/ciy971