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Induction-phase treatment costs for cryptococcal meningitis in high HIV-burden African countries: New opportunities with lower costs

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 compare...

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Autores principales: Larson, Bruce, Shroufi, Amir, Muthoga, Charles, Oladele, Rita, Rajasingham, Radha, Jordan, Alexander, Jarvis, Joseph N., Chiller, Tom M., Govender, Nelesh P.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: F1000 Research Limited 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9184925/
https://www.ncbi.nlm.nih.gov/pubmed/35706922
http://dx.doi.org/10.12688/wellcomeopenres.16776.3
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author Larson, Bruce
Shroufi, Amir
Muthoga, Charles
Oladele, Rita
Rajasingham, Radha
Jordan, Alexander
Jarvis, Joseph N.
Chiller, Tom M.
Govender, Nelesh P.
author_facet Larson, Bruce
Shroufi, Amir
Muthoga, Charles
Oladele, Rita
Rajasingham, Radha
Jordan, Alexander
Jarvis, Joseph N.
Chiller, Tom M.
Govender, Nelesh P.
author_sort Larson, Bruce
collection PubMed
description 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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spelling pubmed-91849252022-06-14 Induction-phase treatment costs for cryptococcal meningitis in high HIV-burden African countries: New opportunities with lower costs Larson, Bruce Shroufi, Amir Muthoga, Charles Oladele, Rita Rajasingham, Radha Jordan, Alexander Jarvis, Joseph N. Chiller, Tom M. Govender, Nelesh P. Wellcome Open Res Research Note 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. F1000 Research Limited 2022-06-20 /pmc/articles/PMC9184925/ /pubmed/35706922 http://dx.doi.org/10.12688/wellcomeopenres.16776.3 Text en Copyright: © 2022 Larson B et al. https://creativecommons.org/licenses/by/4.0/This is an open access article distributed under the terms of the Creative Commons Attribution Licence, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Research Note
Larson, Bruce
Shroufi, Amir
Muthoga, Charles
Oladele, Rita
Rajasingham, Radha
Jordan, Alexander
Jarvis, Joseph N.
Chiller, Tom M.
Govender, Nelesh P.
Induction-phase treatment costs for cryptococcal meningitis in high HIV-burden African countries: New opportunities with lower costs
title Induction-phase treatment costs for cryptococcal meningitis in high HIV-burden African countries: New opportunities with lower costs
title_full Induction-phase treatment costs for cryptococcal meningitis in high HIV-burden African countries: New opportunities with lower costs
title_fullStr Induction-phase treatment costs for cryptococcal meningitis in high HIV-burden African countries: New opportunities with lower costs
title_full_unstemmed Induction-phase treatment costs for cryptococcal meningitis in high HIV-burden African countries: New opportunities with lower costs
title_short Induction-phase treatment costs for cryptococcal meningitis in high HIV-burden African countries: New opportunities with lower costs
title_sort induction-phase treatment costs for cryptococcal meningitis in high hiv-burden african countries: new opportunities with lower costs
topic Research Note
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9184925/
https://www.ncbi.nlm.nih.gov/pubmed/35706922
http://dx.doi.org/10.12688/wellcomeopenres.16776.3
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