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

Chen, Tao ORCID: https://orcid.org/0000-0002-5489-6450, Mwenge, Lawrence, Lakhi, Shabir, Chanda, Duncan, Mwaba, Peter, Molloy, Sile, Gheorghe, Adrian, Griffiths, Ulla, Heyderman, Robert, Kanyama, Cecilia, Kouanfack, Charles, Mfinanga, Sayoki, Chan, Adrienne K, Temfack, Elvis, Kivuyo, Sokoine, Hosseinipour, Mina, Lortholary, Olivier, Loyse, Angela, Jaffar, Shabbar ORCID: https://orcid.org/0000-0002-9615-1588, Harrison, Thomas and Niessen, Louis ORCID: https://orcid.org/0000-0002-8639-5191 (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, Vol 69, Issue 4, pp. 588-595.

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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.

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.

Item Type:	Article
Subjects:	QV Pharmacology > Anti-Inflammatory Agents. Anti-Infective Agents. Antineoplastic Agents > QV 252 Antifungal agents. Antifungal antibiotics WA Public Health > Health Problems of Special Population Groups > WA 395 Health in developing countries WC Communicable Diseases > Mycoses > WC 475 Cryptococcosis. Sporotrichosis WL Nervous System > WL 200 Meninges. Blood-brain barrier
Faculty: Department:	Clinical Sciences & International Health > Clinical Sciences Department
Digital Object Identifer (DOI):	https://doi.org/10.1093/cid/ciy971
Depositing User:	Stacy Murtagh
Date Deposited:	15 Mar 2019 11:16
Last Modified:	24 Oct 2019 08:20
URI:	https://archive.lstmed.ac.uk/id/eprint/10199

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