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

Tao Chen, Lawrence Mwenge, Shabir Lakhi, Duncan Chanda, Peter Mwaba, Síle F. Molloy, Adrian Gheorghe, Ulla K. Griffiths, Robert S. Heyderman, Cecilia Kanyama, Charles Kouanfack, Sayoki Mfinanga, Adrienne K. Chan, Elvis Temfack, Sokoine Kivuyo, Mina C. Hosseinipour, Olivier Lortholary, Angela Loyse, Shabbar Jaffar, Thomas S. HarrisonLouis W. Niessen

Research output: Contribution to journalArticle

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.

Original languageEnglish (US)
Pages (from-to)588-595
Number of pages8
JournalClinical Infectious Diseases
Volume69
Issue number4
DOIs
StatePublished - Aug 15 2019

Keywords

  • antifungal induction treatments
  • cost-effectiveness
  • cryptococcal meningitis
  • flucytosine
  • sub-Saharan Africa

ASJC Scopus subject areas

  • Microbiology (medical)
  • Infectious Diseases

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    Chen, T., Mwenge, L., Lakhi, S., Chanda, D., Mwaba, P., Molloy, S. F., Gheorghe, A., Griffiths, U. K., Heyderman, R. S., Kanyama, C., Kouanfack, C., Mfinanga, S., Chan, A. K., Temfack, E., Kivuyo, S., Hosseinipour, M. C., Lortholary, O., Loyse, A., Jaffar, S., ... Niessen, L. W. (2019). 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. Clinical Infectious Diseases, 69(4), 588-595. https://doi.org/10.1093/cid/ciy971