PharmacoEconomics & Outcomes News 398 - 8 Feb 2003 Preventing opportunistic infections Table. Cost effectiveness of strategies for in HIV worth it in France? preventing opportunistic infections in HIV Prophylactic Lifetime QALE b Cost per Prophylaxis against toxoplasmic encephalitis, strategy costs a (euros) (months) QALY c gained Mycobacterium avium and Pneumocystis carinii (euros) pneumonia using antibacterials is cost effective among No 185 600 112.7 . French patients with HIV infections who are receiving prophylaxis HAART, while prophylaxis against cytomegalovirus Cotrimoxazole 187 900 113.7 18 700 (CMV) and fungal infections "is less cost-effective than Cotrimoxazole, 188 800 114.2 23 900 other recommended treatment strategies for HIV", say azithromycin researchers from France and the US. Cotrimoxazole, 191 200 114.7 54 500 fluconazole They used a decision-analysis model based on Cotrimoxazole, 191 700 114.8 55 000 country-specific data obtained from published clinical azithromycin, trials, the Multicenter AIDS Cohort Study and the fluconazole Tourcoing AIDS Reference Center, to estimate the costs Cotrimoxazole, 197 300 114 strongly and outcomes associated with recommended strategies ganciclovir dominated d for preventing the major opportunistic infections Cotrimoxazole, 199 000 114.5 strongly observed among patients with HIV/AIDS. azithromycin, dominated The model showed that toxoplasmic encephalitis and ganciclovir P. carinii pneumonia prophylaxis with cotrimoxazole Cotrimoxazole, 201 100 115.1 weakly fluconazole, dominated [trimethoprim/sulfamethoxazole] increased quality- ganciclovir adjusted life expectancy (QALE) to 113.7 months, and Cotrimoxazole, 203 600 115.9 130 100 would cost 18 700 euros per quality-adjusted life-year azithromycin, (QALY) gained, compared with no prophylaxis [see fluconazole, table]. M. avium complex bacteraemia prophylaxis ganciclovir comprising the addition of azithromycin to a Costs (2000 values) were those related to antiretroviral and cotrimoxazole would result in a cost effectiveness of 23 prophylactic drug therapy, treatment of opportunistic infections and routine medical care, and were assessed from a societal perspective. 900 euros per QALY gained, compared with Both costs and outcomes were discounted at a rate of 3% per year. cotrimoxazole alone. b quality-adjusted life expectancy However, fungal prophylaxis comprising the addition c quality-adjusted life-year of fluconazole to cotrimoxazole would increase the d more costly and less effective than the next least costly strategy incremental cost-effectiveness ratio further to 54 500 euros per QALY gained, compared with prophylaxis against toxoplasmic encephalitis, M. avium complex Yazdanpanah Y, et al. Prevention of human immunodeficiency virus-related opportunistic infections in France: a cost-effectiveness analysis. Clinical Infectious bacteraemia and P. carinii pneumonia, note the Diseases 36: 86-96, 1 Jan 2003 800931341 researchers. Moreover, CMV prophylaxis comprising the addition of ganciclovir to any regimen was "either dominated by an alternative strategy . . . or was associated with a cost-effectiveness ratio greater than 100, 000 euros compared with the alternative strategy", say the researchers. 1 PharmacoEconomics & Outcomes News 8 Feb 2003 No. 398 1173-5503/10/0398-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved

Preventing opportunistic infections in HIV worth it in France?

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Page 1: Preventing opportunistic infections in HIV worth it in France?

PharmacoEconomics & Outcomes News 398 - 8 Feb 2003

Preventing opportunistic infections Table. Cost effectiveness of strategies forin HIV worth it in France? preventing opportunistic infections in HIV

Prophylactic Lifetime QALEb Cost perProphylaxis against toxoplasmic encephalitis, strategy costsa (euros) (months) QALYc gainedMycobacterium avium and Pneumocystis carinii (euros)pneumonia using antibacterials is cost effective among

No 185 600 112.7 .French patients with HIV infections who are receiving prophylaxisHAART, while prophylaxis against cytomegalovirus Cotrimoxazole 187 900 113.7 18 700(CMV) and fungal infections "is less cost-effective than Cotrimoxazole, 188 800 114.2 23 900other recommended treatment strategies for HIV", say azithromycinresearchers from France and the US. Cotrimoxazole, 191 200 114.7 54 500

fluconazoleThey used a decision-analysis model based onCotrimoxazole, 191 700 114.8 55 000country-specific data obtained from published clinicalazithromycin,trials, the Multicenter AIDS Cohort Study and thefluconazoleTourcoing AIDS Reference Center, to estimate the costs

Cotrimoxazole, 197 300 114 stronglyand outcomes associated with recommended strategies ganciclovir dominatedd

for preventing the major opportunistic infections Cotrimoxazole, 199 000 114.5 stronglyobserved among patients with HIV/AIDS. azithromycin, dominated

The model showed that toxoplasmic encephalitis and ganciclovirP. carinii pneumonia prophylaxis with cotrimoxazole Cotrimoxazole, 201 100 115.1 weakly

fluconazole, dominated[trimethoprim/sulfamethoxazole] increased quality-gancicloviradjusted life expectancy (QALE) to 113.7 months, and

Cotrimoxazole, 203 600 115.9 130 100would cost 18 700 euros per quality-adjusted life-yearazithromycin,(QALY) gained, compared with no prophylaxis [see fluconazole,

table]. M. avium complex bacteraemia prophylaxis ganciclovircomprising the addition of azithromycin to a Costs (2000 values) were those related to antiretroviral andcotrimoxazole would result in a cost effectiveness of 23 prophylactic drug therapy, treatment of opportunistic infections and

routine medical care, and were assessed from a societal perspective.900 euros per QALY gained, compared withBoth costs and outcomes were discounted at a rate of 3% per year.cotrimoxazole alone.b quality-adjusted life expectancyHowever, fungal prophylaxis comprising the additionc quality-adjusted life-yearof fluconazole to cotrimoxazole would increase thed more costly and less effective than the next least costly strategyincremental cost-effectiveness ratio further to 54 500

euros per QALY gained, compared with prophylaxisagainst toxoplasmic encephalitis, M. avium complex Yazdanpanah Y, et al. Prevention of human immunodeficiency virus-related

opportunistic infections in France: a cost-effectiveness analysis. Clinical Infectiousbacteraemia and P. carinii pneumonia, note theDiseases 36: 86-96, 1 Jan 2003 800931341researchers. Moreover, CMV prophylaxis comprising

the addition of ganciclovir to any regimen was "eitherdominated by an alternative strategy . . . or wasassociated with a cost-effectiveness ratio greater than100, 000 euros compared with the alternative strategy",say the researchers.