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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.
- Source :
-
Clinical infectious diseases : an official publication of the Infectious Diseases Society of America [Clin Infect Dis] 2019 Aug 01; Vol. 69 (4), pp. 588-595. - Publication Year :
- 2019
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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.<br />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.<br />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.<br />Clinical Trials Registration: ISRCTN45035509.<br />Conclusions: Both 1 week of AmB and 5FC and 2 weeks of Oral FLU and 5FC are cost-effective treatments.<br /> (© The Author(s) 2019. Published by Oxford University Press for the Infectious Diseases Society of America.)
- Subjects :
- Africa South of the Sahara
Flucytosine economics
Flucytosine therapeutic use
Health Care Costs statistics & numerical data
Humans
Antifungal Agents economics
Antifungal Agents therapeutic use
Meningitis, Cryptococcal diagnosis
Meningitis, Cryptococcal economics
Meningitis, Cryptococcal epidemiology
Meningitis, Cryptococcal therapy
Subjects
Details
- Language :
- English
- ISSN :
- 1537-6591
- Volume :
- 69
- Issue :
- 4
- Database :
- MEDLINE
- Journal :
- Clinical infectious diseases : an official publication of the Infectious Diseases Society of America
- Publication Type :
- Academic Journal
- Accession number :
- 30863852
- Full Text :
- https://doi.org/10.1093/cid/ciy971