The cost-effectiveness of fluconazole prophylaxis against primary systemic fungal infections in AIDS patients.
OBJECTIVE
To project the cost-effectiveness of fluconazole for prophylaxis against AIDS-related primary systemic fungal infections.


METHODS
A Markov model with data from the literature.


METHODS
Hypothetical cohort of 100,000 AIDS patients.


METHODS
No prophylaxis, and fluconazole prophylaxis beginning when a patient's CD4 count declined to below 200/mm3, below 100/mm3, or below 50/mm3.


RESULTS
The no-prophylaxis policy was associated with a discounted life expectancy of 28.20 months and direct medical costs of $36,100 per person. The < 200/mm3 strategy increased costs to $40,500 and life expectancy to 28.42 months, producing a ratio of $240,000 per year of life saved (YLS). Compared with the no-prophylaxis and < 200/mm3 policies, the intermediate alternatives were less economically efficient. A reduction in fluconazole's cost from $206 to $80 decreased the ratio to $50,000 for the < 200/mm3 strategy. Doubling fungal infection incidence lowered this ratio to $96,000/YLS.


CONCLUSIONS
Fluconazole prophylaxis is unlikely to be cost-effective unless its cost is lowered, or it is focused on patients in regions endemic for fungal infections.
Scharfstein
J A
JA
Department of Biostatistics, Harvard School of Public Health, Boston, MA, USA.
Paltiel
A D
AD
Freedberg
K A
KA
D017088:AIDS-Related Opportunistic Infections / Q000188:drug therapy* / Q000191:economics / Q000401:mortality; D000935:Antifungal Agents / Q000191:economics / Q000627:therapeutic use*; D018791:CD4 Lymphocyte Count; D003362:Cost-Benefit Analysis; D016527:Drug Costs; D015725:Fluconazole / Q000191:economics / Q000627:therapeutic use*; D006801:Humans; D008390:Markov Chains; D008954:Models, Biological; D008962:Models, Theoretical; D009181:Mycoses / Q000191:economics / Q000401:mortality / Q000517:prevention & control*; D016019:Survival Analysis; D014481:United States / Q000453:epidemiology
D000935:Antifungal Agents; D015725:Fluconazole