1. 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.
- Author
-
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, and Harrison, Thomas S
- Subjects
- *
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 - 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. [ABSTRACT FROM AUTHOR]
- Published
- 2019
- Full Text
- View/download PDF