Cost-Effectiveness of Amphotericin B Deoxycholate Versus Itraconazole for Induction Therapy of Talaromycosis in Human Immunodeficiency Virus-Infected Adults in Vietnam.
Background
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.


Methods
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.


Results
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.


Conclusions
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.
['Buchanan|James|J|https://orcid.org/0000-0003-2528-0638', 'Altunkaya|James|J|', 'Van Kinh|Nguyen|N|', 'Van Vinh Chau|Nguyen|N|', 'Trieu Ly|Vo|V|', 'Thi Thanh Thuy|Pham|P|', 'Hai Vinh|Vu|V|', 'Thi Hong Hanh|Doan|D|', 'Thuy Hang|Nguyen|N|', 'Phuong Thuy|Tran|T|', 'van Doorn|Rogier|R|', 'Thwaites|Guy|G|', 'Gray|Alastair|A|', 'Le|Thuy|T|https://orcid.org/0000-0002-3393-6580']
cost-effectiveness amphotericin B itraconazole talaromycosis HIV