title: The cost-effectiveness of fluconazole prophylaxis against primary systemic fungal infections in AIDS patients.
abstract: 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.
authors.affiliation: Department of Biostatistics, Harvard School of Public Health, Boston, MA, USA.
authors.forename: J A
authors.initials: JA
authors.lastname: Scharfstein
authors.forename: A D
authors.initials: AD
authors.lastname: Paltiel
authors.forename: K A
authors.initials: KA
authors.lastname: Freedberg
mesh_terms: 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
chemical_list: D000935:Antifungal Agents; D015725:Fluconazole