Buchanan James, Altunkaya James, Van Kinh Nguyen, Van Vinh Chau Nguyen, Trieu Ly Vo, Thi Thanh Thuy Pham, Hai Vinh Vu, Thi Hong Hanh Doan, Thuy Hang Nguyen, Phuong Thuy Tran, van Doorn Rogier, Thwaites Guy, Gray Alastair, Le Thuy
Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom.
National Hospital for Tropical Diseases, Hanoi, Vietnam.
Open Forum Infect Dis. 2021 Jul 5;8(7):ofab357. doi: 10.1093/ofid/ofab357. eCollection 2021 Jul.
Talaromycosis (penicilliosis) is an invasive fungal infection and a major cause of human immunodeficiency virus (HIV)-related deaths in Southeast Asia. Guidelines recommend induction therapy with amphotericin B deoxycholate; however, treatment with itraconazole has fewer toxic effects, is easier to administer, and is less expensive. Our recent randomized controlled trial in Vietnam found that amphotericin B was superior to itraconazole with respect to 6-month mortality. We undertook an economic evaluation alongside this trial to determine whether the more effective treatment is cost-effective.
Resource use, direct and indirect costs, and health and quality-of-life outcomes (measured using quality-adjusted life-years [QALYs]) were evaluated for 405 trial participants from 2012 to 2016. Both a Vietnamese health service and a broader societal costing perspective were considered. Mean costs and QALYs were combined to calculate the within-trial cost-effectiveness of amphotericin vs itraconazole from both perspectives.
From a Vietnamese health service perspective, amphotericin increases costs but improves health outcomes compared to itraconazole, at a cost of $3013/QALY gained. The probability that amphotericin is cost-effective at a conventional (World Health Organization CHOICE) threshold of value for money is 46%. From a societal perspective, amphotericin is cost-reducing and improves outcomes compared to itraconazole, and is likely to be a cost-effective strategy at any value for money threshold greater than $0.
Our analysis indicates that induction therapy with amphotericin is a cost-effective treatment strategy for HIV-infected adults diagnosed with talaromycosis in Vietnam. These results provide the evidence base for health care providers and policy makers to improve access to and use of amphotericin.
足分支霉病（青霉病）是一种侵袭性真菌感染，是东南亚地区人类免疫缺陷病毒（HIV）相关死亡的主要原因。指南推荐使用去氧胆酸两性霉素B进行诱导治疗；然而，伊曲康唑治疗的毒性作用较少，给药更容易，且成本更低。我们最近在越南进行的随机对照试验发现，在6个月死亡率方面，两性霉素B优于伊曲康唑。我们在该试验的同时进行了一项经济评估，以确定更有效的治疗方法是否具有成本效益。
对2012年至2016年期间405名试验参与者的资源使用、直接和间接成本以及健康和生活质量结果（使用质量调整生命年[QALY]衡量）进行了评估。同时考虑了越南卫生服务和更广泛的社会成本视角。将平均成本和QALY结合起来，从两个角度计算两性霉素与伊曲康唑在试验中的成本效益。
从越南卫生服务的角度来看，与伊曲康唑相比，两性霉素增加了成本，但改善了健康结果，每获得一个QALY的成本为3013美元。在传统的（世界卫生组织选择）性价比阈值下，两性霉素具有成本效益的概率为46%。从社会角度来看，与伊曲康唑相比，两性霉素降低了成本并改善了结果，并且在任何大于0美元的性价比阈值下都可能是一种具有成本效益的策略。
我们的分析表明，对于在越南被诊断为足分支霉病的HIV感染成人，使用两性霉素进行诱导治疗是一种具有成本效益的治疗策略。这些结果为医疗保健提供者和政策制定者改善两性霉素的可及性和使用提供了证据基础。
