{"doi":"10.1093/cid/ciy971","title":"Healthcare Costs and Life-years Gained From Treatments Within the Advancing Cryptococcal Meningitis Treatment for Africa (ACTA) Trial on Cryptococcal Meningitis: A Comparison of Antifungal Induction Strategies in Sub-Saharan Africa","abstract":"<jats:title>Abstract</jats:title>\n               <jats:sec>\n                  <jats:title>Background</jats:title>\n                  <jats:p>Mortality from cryptoccocal meningitis remains high. The ACTA trial demonstrated that, compared with 2 weeks of amphotericin B (AmB) plus flucystosine (5FC), 1 week of AmB and 5FC was associated with lower mortality and 2 weeks of oral flucanozole (FLU) plus 5FC was non-inferior. Here, we assess the cost-effectiveness of these different treatment courses.</jats:p>\n               </jats:sec>\n               <jats:sec>\n                  <jats:title>Methods</jats:title>\n                  <jats:p>Participants were randomized in a ratio of 2:1:1:1:1 to 2 weeks of oral 5FC and FLU, 1 week of AmB and FLU, 1 week of AmB and 5FC, 2 weeks of AmB and FLU, or 2 weeks of AmB and 5FC in Malawi, Zambia, Cameroon, and Tanzania. Data on individual resource use and health outcomes were collected. Cost-effectiveness was measured as incremental costs per life-year saved, and non-parametric bootstrapping was done.</jats:p>\n               </jats:sec>\n               <jats:sec>\n                  <jats:title>Results</jats:title>\n                  <jats:p>Total costs per patient were US $1442 for 2 weeks of oral FLU and 5FC, $1763 for 1 week of AmB and FLU, $1861 for 1 week of AmB and 5FC, $2125 for 2 weeks of AmB and FLU, and $2285 for 2 weeks of AmB and 5FC. Compared to 2 weeks of AmB and 5FC, 1 week of AmB and 5FC was less costly and more effective and 2 weeks of oral FLU and 5FC was less costly and as effective. The incremental cost-effectiveness ratio for 1 week of AmB and 5FC versus oral FLU and 5FC was US $208 (95% confidence interval $91–1210) per life-year saved.</jats:p>\n               </jats:sec>\n               <jats:sec>\n                  <jats:title>Clinical Trials Registration</jats:title>\n                  <jats:p>ISRCTN45035509.</jats:p>\n               </jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions</jats:title>\n                  <jats:p>Both 1 week of AmB and 5FC and 2 weeks of Oral FLU and 5FC are cost-effective treatments.</jats:p>\n               </jats:sec>","journal":"Clinical Infectious Diseases","year":2019,"id":624339,"datarank":0.4887144807032224,"base_score":3.258096538021482,"endowment":3.258096538021482,"self_citation_contribution":0.4887144807032224,"citation_network_contribution":0.0,"self_endowment_contribution":0.4887144807032224,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":25,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":null,"is_data_producer":false,"deposit_databanks":null,"is_oa":false,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":null,"fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":670587,"name":"Lawrence Mwenge","orcid":"0000-0002-8588-8939","position":1,"is_corresponding":false},{"id":292864,"name":"Shabir Lakhi","orcid":"0000-0001-5348-7156","position":2,"is_corresponding":false},{"id":716642,"name":"Duncan Chanda","orcid":"0000-0001-5477-9054","position":3,"is_corresponding":false},{"id":614650,"name":"Peter Mwaba","orcid":"0000-0003-3275-4934","position":4,"is_corresponding":false},{"id":1613954,"name":"Síle F Molloy","orcid":null,"position":5,"is_corresponding":false},{"id":356817,"name":"Adrian Gheorghe","orcid":"0000-0002-0517-8807","position":6,"is_corresponding":false},{"id":1613957,"name":"Ulla K Griffiths","orcid":null,"position":7,"is_corresponding":false},{"id":1613958,"name":"Robert S Heyderman","orcid":null,"position":8,"is_corresponding":false},{"id":1122644,"name":"Cecilia Kanyama","orcid":"0000-0001-8673-3763","position":9,"is_corresponding":false},{"id":772629,"name":"Charles Kouanfack","orcid":"0000-0002-0238-6205","position":10,"is_corresponding":false},{"id":439737,"name":"Sayoki Mfinanga","orcid":"0000-0001-9067-2684","position":11,"is_corresponding":false},{"id":735384,"name":"Adrienne K Chan","orcid":"0000-0002-3185-192X","position":12,"is_corresponding":false},{"id":735382,"name":"Elvis Temfack","orcid":"0000-0001-8189-6555","position":13,"is_corresponding":false},{"id":443253,"name":"Sokoine Kivuyo","orcid":"0000-0003-2257-5254","position":14,"is_corresponding":false},{"id":1404982,"name":"Mina C Hosseinipour","orcid":null,"position":15,"is_corresponding":false},{"id":410999,"name":"Olivier Lortholary","orcid":"0000-0002-8325-8060","position":16,"is_corresponding":false},{"id":495636,"name":"Angela Loyse","orcid":"0000-0001-7853-1344","position":17,"is_corresponding":false},{"id":735386,"name":"Shabbar Jaffar","orcid":"0000-0002-9615-1588","position":18,"is_corresponding":false},{"id":1613959,"name":"Thomas S Harrison","orcid":null,"position":19,"is_corresponding":false},{"id":1613960,"name":"Louis W Niessen","orcid":null,"position":20,"is_corresponding":false},{"id":655692,"name":"Tao Chen","orcid":"0000-0002-6552-3457","position":0,"is_corresponding":false}],"reference_count":0,"raw_metadata":{"has_enrichment":true,"resolved":true,"title":"Healthcare Costs and Life-years Gained From Treatments Within the Advancing Cryptococcal Meningitis Treatment for Africa (ACTA) Trial on Cryptococcal Meningitis: A Comparison of Antifungal Induction Strategies in Sub-Saharan Africa","abstract":"<jats:title>Abstract</jats:title>\n               <jats:sec>\n                  <jats:title>Background</jats:title>\n                  <jats:p>Mortality from cryptoccocal meningitis remains high. The ACTA trial demonstrated that, compared with 2 weeks of amphotericin B (AmB) plus flucystosine (5FC), 1 week of AmB and 5FC was associated with lower mortality and 2 weeks of oral flucanozole (FLU) plus 5FC was non-inferior. Here, we assess the cost-effectiveness of these different treatment courses.</jats:p>\n               </jats:sec>\n               <jats:sec>\n                  <jats:title>Methods</jats:title>\n                  <jats:p>Participants were randomized in a ratio of 2:1:1:1:1 to 2 weeks of oral 5FC and FLU, 1 week of AmB and FLU, 1 week of AmB and 5FC, 2 weeks of AmB and FLU, or 2 weeks of AmB and 5FC in Malawi, Zambia, Cameroon, and Tanzania. Data on individual resource use and health outcomes were collected. Cost-effectiveness was measured as incremental costs per life-year saved, and non-parametric bootstrapping was done.</jats:p>\n               </jats:sec>\n               <jats:sec>\n                  <jats:title>Results</jats:title>\n                  <jats:p>Total costs per patient were US $1442 for 2 weeks of oral FLU and 5FC, $1763 for 1 week of AmB and FLU, $1861 for 1 week of AmB and 5FC, $2125 for 2 weeks of AmB and FLU, and $2285 for 2 weeks of AmB and 5FC. Compared to 2 weeks of AmB and 5FC, 1 week of AmB and 5FC was less costly and more effective and 2 weeks of oral FLU and 5FC was less costly and as effective. The incremental cost-effectiveness ratio for 1 week of AmB and 5FC versus oral FLU and 5FC was US $208 (95% confidence interval $91–1210) per life-year saved.</jats:p>\n               </jats:sec>\n               <jats:sec>\n                  <jats:title>Clinical Trials Registration</jats:title>\n                  <jats:p>ISRCTN45035509.</jats:p>\n               </jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions</jats:title>\n                  <jats:p>Both 1 week of AmB and 5FC and 2 weeks of Oral FLU and 5FC are cost-effective treatments.</jats:p>\n               </jats:sec>","is_dataset_classified":null,"base_score":3.258096538021482,"endowment":3.258096538021482,"datacite_reuse_total":0,"file_count":0,"downloads":0,"views":0,"has_version_chain":false,"is_dataset":false,"is_oa":false,"pmid":"30863852","pmcid":"PMC6669289","openalex_id":"https://openalex.org/W2921003155","authors":[],"funders":[{"funder_name":"Medical Research Council","grant_id":"100504","title":null},{"funder_name":"French Agency for Research on AIDS and Viral Hepatitis","grant_id":"ANRS12275","title":null},{"funder_name":"Medical Research Council","grant_id":"G1100814","title":null},{"funder_name":"FIC NIH HHS","grant_id":"D43 TW010060","title":null},{"funder_name":"Wellcome Trust","grant_id":"unidentified","title":"unidentified"},{"funder_name":"Wellcome Trust","grant_id":"","title":null},{"funder_name":"Wellcome Trust","grant_id":"","title":null}],"total_grants":7,"fwci":1.8031,"citation_percentile":0.8553156,"influential_citations":0,"citation_trend":[{"year":2019,"count":2},{"year":2020,"count":3},{"year":2021,"count":7},{"year":2022,"count":5},{"year":2023,"count":3},{"year":2024,"count":2},{"year":2026,"count":3}],"oa_status":"hybrid","license":"cc-by","oa_locations":[{"url":"https://academic.oup.com/cid/article-pdf/69/4/588/29022085/ciy971.pdf","host_type":"journal"},{"url":"https://academic.oup.com/cid/article-pdf/69/4/588/29022085/ciy971.pdf","host_type":"publisher"},{"url":"http://academic.oup.com/cid/article-pdf/69/4/588/29022085/ciy971.pdf","host_type":"publisher"},{"url":"https://doi.org/10.1093/cid/ciy971","host_type":"journal"},{"url":"https://pubmed.ncbi.nlm.nih.gov/30863852","host_type":"repository"},{"url":"http://openaccess.sgul.ac.uk/110685/12/ciy971_suppl_supplementary_material.docx","host_type":"repository"},{"url":"https://discovery.ucl.ac.uk/id/eprint/10083696/","host_type":"repository"},{"url":"https://www.ncbi.nlm.nih.gov/pmc/articles/6669289","host_type":"repository"},{"url":"https://europepmc.org/articles/PMC6669289","host_type":"Europe_PMC"},{"url":"https://europepmc.org/articles/PMC6669289?pdf=render","host_type":"Europe_PMC"},{"url":"https://dx.doi.org/10.60692/t91r1-phc87","host_type":""},{"url":"https://dx.doi.org/10.60692/n5vat-15y77","host_type":""},{"url":"http://dx.doi.org/10.1093/cid/ciy971","host_type":""},{"url":"https://dx.doi.org/10.1093/cid/ciy971","host_type":""},{"url":"https://discovery-pp.ucl.ac.uk/id/eprint/10083696/","host_type":""}],"fields_of_study":["Fungal Infections and Studies","Nail Diseases and Treatments","Insects and Parasite Interactions","03 medical and health sciences","0302 clinical medicine","0305 other medical science","Africa South of the Sahara","Antifungal Agents","Flucytosine","Health Care Costs","Humans","Meningitis, Cryptococcal"],"mesh_terms":["Antifungal Agents","Flucytosine","Humans","Meningitis, Cryptococcal","Health Care Costs","Africa South of the Sahara"],"keywords":["Cryptococcal meningitis","Medicine","Antifungal","Meningitis","Intensive care medicine","Health care","Pediatrics","Immunology","Human immunodeficiency virus (HIV)","Viral disease","Dermatology","Economic growth","Sub-Saharan Africa","flucytosine","Cost-effectiveness","Antifungal Induction Treatments","Diagnosis and Management of Fungal Infections","Antifungal Agents","Epidemiology","Meningitis, Cryptococcal","FOS: Health sciences","Epidemiology and Management of Fungal Infections","Amphotericin B","Health Sciences","Humans","Articles and Commentaries","Internal medicine","Africa South of the Sahara","FOS: Clinical medicine","Confidence interval","Health Care Costs","Infectious Diseases","Epidemiology and Management of Fungal Skin Infections","Antifungal Therapy","Randomized controlled trial"],"sdg_mappings":[{"sdg_number":3,"sdg_label":"3. 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