期刊论文详细信息
Wellcome Open Research
Induction-phase treatment costs for cryptococcal meningitis in high HIV-burden African countries: New opportunities with lower costs
article
Bruce Larson1  Amir Shroufi3  Charles Muthoga4  Rita Oladele5  Radha Rajasingham6  Alexander Jordan7  Joseph N. Jarvis4  Tom M. Chiller7  Nelesh P. Govender9 
[1] Global Health, Boston University School of Public Health;Health Economics and Epidemiology Research Office, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand;CDC Foundation;Botswana Harvard AIDS Institute Partnership;College of Medicine, Univerity of Lagos;Division of Infectious Diseases & International Medicine, University of Minnesota;Mycotic Diseases Branch, Centers for Disease Controls and Prevention;Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine;National Institute for Communicable Diseases, National Health Laboratory Service;University of Witwatersrand
关键词: HIV/AIDS;    cryptococcal meningitis;    induction phase;    amphotericin B deoxycholate;    flucytosine;    liposomal amphotericin B;    fluconazole;    South Africa;    Uganda;    Botswana;    Nigeria;   
DOI  :  10.12688/wellcomeopenres.16776.3
学科分类:内科医学
来源: Wellcome
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【 摘 要 】

Introduction: Access to and the cost of induction treatment for cryptococcal meningitis (CM) is rapidly changing. The newly-announced price for flucytosine ($0.75 per 500 mg pill) and possibly lower prices for liposomal amphotericin B (AmB-L) create opportunities to reduce CM treatment costs compared to the current standard treatment in low- and middle-income countries.Methods: We developed an Excel-based cost model to estimate health system treatment costs for CM over a two-week induction phase for multiple treatment combinations, newly feasible with improved access to flucytosine and AmB-L. CM treatment costs include medications, laboratory tests and other hospital-based costs (bed-day costs and healthcare worker time). We report results from applying the model using country-specific information for South Africa, Uganda, Nigeria, and Botswana.Results: A 14-day induction-phase of seven days of inpatient AmB-D with flucytosine, followed by seven days of high-dose fluconazole as an outpatient, will cost health systems less than a 14-day hospital stay with AmB-D and fluconazole. If daily AmB-L replaces AmB-D for those with baseline renal dysfunction, with a cost of $50 or less per 50 mg vial, incremental costs would still be less than the AmB-D with fluconazole regimen. Simple oral combinations (e.g., seven days of flucytosine with fluconazole as an inpatient) are practical when AmB-D is not available, and treatment costs would remain less than the current standard treatment.Conclusions: Improved access to and lower prices for flucytosine and AmB-L create opportunities for improving CM treatment regimens. An induction regimen of flucytosine and AmB-D for seven days is less costly than standard care in the settings studied here. As this regimen has also been shown to be more effective than current standard care, countries should prioritize scaling up flucytosine access. The cost of AmB-L based regimens is highly dependent on the price of AmB-L, which currently remains unclear.

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