原创力文档cryptococcal meningitis treatment strategies in resource-limited settings a cost-effectiveness analysis隐球菌脑膜炎治疗策略在资源有限的环境成本效益分析.pdfVIP
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cryptococcal meningitis treatment strategies in resource-limited settings a cost-effectiveness analysis隐球菌脑膜炎治疗策略在资源有限的环境成本效益分析
Cryptococcal Meningitis Treatment Strategies in
Resource-Limited Settings: A Cost-Effectiveness Analysis
1,2 2 2 1,2 2
Radha Rajasingham , Melissa A. Rolfes , Kate E. Birkenkamp , David B. Meya , David R. Boulware *
1 Infectious Disease Institute, Makerere University, Kampala, Uganda, 2 Division of Infectious Diseases International Medicine, Department of Medicine, University of
Minnesota, Minneapolis, Minnesota, United States of America
Abstract
Background: Cryptococcal meningitis (CM) is the most common form of meningitis in Africa. World Health Organization
guidelines recommend 14-d amphotericin-based induction therapy; however, this is impractical for many resource-limited
settings due to cost and intensive monitoring needs. A cost-effectiveness analysis was performed to guide stakeholders
with respect to optimal CM treatment within resource limitations.
Methods and Findings:: We conducted a decision analysis to estimate the incremental cost-effectiveness ratio (ICER) of six
CM induction regimens: fluconazole (800–1,200 mg/d) monotherapy, fluconazole + flucytosine (5FC), short-course
amphotericin (7-d) + fluconazole, 14-d of amphotericin alone, amphotericin + fluconazole, and amphotericin + 5FC. We
computed actual 2012 healthcare costs in Uganda for medications, supplies, and personnel, and average laboratory costs
for three African countries. A systematic review of cryptococcal treatment trials in resource-limited areas summarized 10-wk
survival outcomes. We modeled one-year survival based on South African, Ugandan, and Thai CM outcome data, and
survival beyond one-year on Ugandan and Thai data. Quality-adjus
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