Larson Bruce, Shroufi Amir, Muthoga Charles, Oladele Rita, Rajasingham Radha, Jordan Alexander, Jarvis Joseph N, Chiller Tom M, Govender Nelesh P
Global Health, Boston University School of Public Health, Boston, MA, 02118, USA.
Health Economics and Epidemiology Research Office, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
Wellcome Open Res. 2022 Jun 20;6:140. doi: 10.12688/wellcomeopenres.16776.3. eCollection 2021.
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. 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. 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. : 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.
隐球菌性脑膜炎（CM）诱导治疗的可及性和成本正在迅速变化。新公布的氟胞嘧啶价格（每500毫克药丸0.75美元）以及脂质体两性霉素B（AmB-L）可能更低的价格，为低收入和中等收入国家降低CM治疗成本创造了机会，与当前标准治疗相比。我们开发了一个基于Excel的成本模型，以估计多种治疗组合在两周诱导期内CM的卫生系统治疗成本，随着氟胞嘧啶和AmB-L可及性的改善，这些组合新变得可行。CM治疗成本包括药物、实验室检查和其他基于医院的成本（床位日成本和医护人员时间）。我们报告了使用南非、乌干达、尼日利亚和博茨瓦纳的特定国家信息应用该模型的结果。为期14天的诱导期，先住院7天使用两性霉素D加氟胞嘧啶，然后门诊7天使用高剂量氟康唑，这将使卫生系统的成本低于住院14天使用两性霉素D和氟康唑的成本。如果对于基线肾功能不全者每日使用AmB-L替代AmB-D，每50毫克小瓶成本为50美元或更低，增量成本仍将低于两性霉素D加氟康唑方案。当无法获得AmB-D时，简单的口服组合（如住院7天使用氟胞嘧啶加氟康唑）是可行的，且治疗成本仍将低于当前标准治疗。：氟胞嘧啶和AmB-L可及性的改善以及价格的降低为改进CM治疗方案创造了机会。在这里研究的环境中，为期7天的氟胞嘧啶和两性霉素D诱导方案比标准治疗成本更低。由于该方案也已被证明比当前标准治疗更有效，各国应优先扩大氟胞嘧啶的可及性。基于AmB-L的方案成本高度依赖于AmB-L的价格，目前价格仍不明确。
