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

被引：15

作者：

Chen, Tao ^{[1
]}

Mwenge, Lawrence ^{[2
]}

Lakhi, Shabir ^{[3
]}

Chanda, Duncan ^{[4
]}

Mwaba, Peter ^{[5
,6
]}

Molloy, Sile F. ^{[7
]}

Gheorghe, Adrian ^{[8
]}

Griffiths, Ulla K. ^{[8
]}

Heyderman, Robert S. ^{[9
,10
,11
]}

Kanyama, Cecilia ^{[12
]}

Kouanfack, Charles ^{[13
,14
]}

Mfinanga, Sayoki ^{[2
,15
]}

Chan, Adrienne K. ^{[16
,17
]}

Temfack, Elvis ^{[18
,19
]}

Kivuyo, Sokoine ^{[15
]}

Hosseinipour, Mina C. ^{[12
,20
]}

Lortholary, Olivier ^{[19
,21
]}

Loyse, Angela ^{[7
]}

Jaffar, Shabbar ^{[1
]}

Harrison, Thomas S. ^{[7
]}

Niessen, Louis W. ^{[1
,22
]}

机构：

[1] Univ Liverpool Liverpool Sch Trop Med, Pembroke Pl, Liverpool L3 5QA, Merseyside, England

[2] Lusaka Apex Med Univ, Zambart, Hlth Econ Unit, Lusaka, Zambia

[3] Lusaka Apex Med Univ, Univ Teaching Hosp, Lusaka, Zambia

[4] Lusaka Apex Med Univ, Univ Teaching Hosp, Inst Med Res & Training, Lusaka, Zambia

[5] Lusaka Apex Med Univ, Dept Internal Med, Lusaka, Zambia

[6] Lusaka Apex Med Univ, Directorate Res & Postgrad Studies, Lusaka, Zambia

[7] St Georges Univ London, Inst Infect & Immun, Ctr Global Hlth, London, England

[8] London Sch Hyg & Trop Med, London, England

[9] Univ Malawi, Malawi Liverpool Wellcome Trust Clin Res Program, Blantyre, Malawi

[10] Univ Malawi, Coll Med, Blantyre, Malawi

[11] UCL, London, England

[12] Kamuzu Cent Hosp, Univ North Carolina Project Malawi, Lilongwe, Malawi

[13] Site Agence Natl Rech Sida Cameroun, Hop Cent Yaounde, Yaounde, Cameroon

[14] Univ Dschang, Dschang, Cameroon

[15] Muhimbili Med Res Ctr, Natl Inst Med Res, Dar Es Salaam, Tanzania

[16] Zomba Cent Hosp, Dignitas Int, Zomba, Malawi

[17] Univ Toronto, Sunnybrook Hlth Sci Ctr, Dept Med, Div Infect Dis, Toronto, ON, Canada

[18] Douala Gen Hosp, Douala, Cameroon

[19] Inst Pasteur, Mol Mycol Unit, 25-28 Rue Dr Roux, F-75015 Paris, France

[20] Univ N Carolina, Chapel Hill, NC 27515 USA

[21] Paris Descartes Univ, Necker Pasteur Ctr Infect Dis & Trop Med, Imagine Inst, AP HP, Paris, France

[22] Johns Hopkins Sch Publ Hlth, Dept Int Hlth, Baltimore, MD USA

来源：

CLINICAL INFECTIOUS DISEASES | 2019年 / 69卷 / 04期

基金：

英国医学研究理事会; 英国惠康基金;

关键词：

cryptococcal meningitis; antifungal induction treatments; cost-effectiveness; flucytosine; sub-Saharan Africa; ECONOMIC-EVALUATION; DISEASE;

D O I：

10.1093/cid/ciy971

中图分类号：

R392 [医学免疫学]; Q939.91 [免疫学];

学科分类号：

100102 ;

摘要：

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. Conclusions. Both 1 week of AmB and 5FC and 2 weeks of Oral FLU and 5FC are cost-effective treatments.

引用

页码：588 / 595

页数：8

共 21 条

[1]

Barber JA, 2000, STAT MED, V19, P3219, DOI 10.1002/1097-0258(20001215)19:23<3219::AID-SIM623>3.0.CO

[2]

2-P

[3] When cost-effective interventions are unaffordable: Integrating cost-effectiveness and budget impact in priority setting for global health programs [J].

Bilinski, Alyssa ;

Neumann, Peter ;

Cohen, Joshua ;

Thorat, Teja ;

McDaniel, Katherine ;

Salomon, Joshua A. .

PLOS MEDICINE, 2017, 14 (10)

[4] Need for differential discounting of costs and health effects in cost effectiveness analyses [J].

Brouwer, WBF ;

Niessen, LW ;

Postma, MJ ;

Rutten, FFH .

BRITISH MEDICAL JOURNAL, 2005, 331 (7514) :446-448

[5]

Drummond M, 2005, MED CARE, V43, P5

[6] A Prospective Study of Mortality from Cryptococcal Meningitis following Treatment Induction with 1200mg Oral Fluconazole in Blantyre, Malawi [J].

Gaskell, Katherine M. ;

Rothe, Camilla ;

Gnanadurai, Roshina ;

Goodson, Patrick ;

Jassi, Chikondi ;

Heyderman, Robert S. ;

Allain, Theresa J. ;

Harrison, Thomas S. ;

Lalloo, David G. ;

Sloan, Derek J. ;

Feasey, Nicholas A. .

PLOS ONE, 2014, 9 (11)

[7] Discounting in economic evaluations: Stepping forward towards optimal decision rules [J].

Gravelle, Hugh ;

Brouwer, Werner ;

Niessen, Louis ;

Postma, Maarten ;

Rutten, Frans .

HEALTH ECONOMICS, 2007, 16 (03) :307-317

[8] Cost-effectiveness of eye care services in Zambia [J].

Griffiths, Ulla K. ;

Bozzani, Fiammetta M. ;

Gheorghe, Adrian ;

Mwenge, Lawrence ;

Gilbert, Clare .

COST EFFECTIVENESS AND RESOURCE ALLOCATION, 2014, 12

[9]

Horton S., COST EFFECTIVENESS A

[10] Consolidated Health Economic Evaluation Reporting Standards (CHEERS) Statement [J].

Husereau, Don ;

Drummond, Michael ;

Petrou, Stavros ;

Carswell, Chris ;

Moher, David ;

Greenberg, Dan ;

Augustovski, Federico ;

Briggs, Andrew H. ;

Mauskopf, Josephine ;

Loder, Elizabeth .

VALUE IN HEALTH, 2013, 16 (02) :E1-E5

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