Freedberg K A, Tosteson A N, Cohen C J, Cotton D J
Department of Medicine, Boston City Hospital, Boston University School of Medicine, MA 02118.
J Acquir Immune Defic Syndr (1988). 1991;4(5):521-31.
We developed a decision-analytic model to assess the effectiveness and costs of dapsone, trimethoprim-sulfamethoxazole, or aerosolized pentamidine as initial prophylaxis for Pneumocystis carinii pneumonia in human immunodeficiency virus-infected people without prior symptoms AIDS and with CD4 counts less than 200/mm3. Each strategy increased life expectancy by about 18% compared with no prophylaxis; annual per-person costs were $440, $700, and $1,680 for dapsone, trimethoprim-sulfamethoxazole, and aerosolized pentamidine, respectively. These cost differences make a strategy beginning with dapsone most cost effective, with an incremental cost-effectiveness ratio of $13,400 per life year saved compared with no prophylaxis. Aerosolized pentamidine was substantially less cost effective, but the incremental cost effectiveness ratios were highly dependent on estimates for quality of life, efficacy, toxicity, and compliance. We conclude that, based on currently available data, initial prophylaxis with either dapsone or trimethoprim-sulfamethoxazole is most cost effective. For every 100,000 people treated, starting prophylaxis with trimethoprim-sulfamethoxazole or dapsone--with crossover to aerosolized pentamidine if oral therapy is not tolerated--may save between $98 million and $124 million per year.
我们建立了一个决策分析模型，以评估氨苯砜、复方新诺明或雾化喷他脒作为初始预防药物，对无症状的艾滋病病毒感染者且CD4细胞计数低于200/mm³的人群预防卡氏肺孢子虫肺炎的有效性和成本。与不进行预防相比，每种策略均使预期寿命提高了约18%；氨苯砜、复方新诺明和雾化喷他脒的人均年成本分别为440美元、700美元和1680美元。这些成本差异使得以氨苯砜开始的策略最具成本效益，与不进行预防相比，每挽救一个生命年的增量成本效益比为13400美元。雾化喷他脒的成本效益明显较低，但其增量成本效益比高度依赖于生活质量、疗效、毒性和依从性的估计。我们得出结论，根据目前可得的数据，以氨苯砜或复方新诺明进行初始预防最具成本效益。对于每10万人进行治疗，若开始用复方新诺明或氨苯砜进行预防——若无法耐受口服治疗则改用雾化喷他脒——每年可能节省9800万至1.24亿美元。
