title: Estimating the cost effectiveness of atovaquone versus intravenous pentamidine in the treatment of mild-to-moderate Pneumocystis carinii pneumonia.
abstract: Pneumocystis carinii pneumonia (PCP) is the most common severe opportunistic infection, and one of the most costly, among people with AIDS. Over 50% of patients experience toxic effects of the major anti-PCP medications- cotrimoxazole (trimethoprim-sulfamethoxazole) and pentamidine. Recently, the US Food and Drug Administration approved a new oral drug therapy, atovaquone, as an alternative to pentamidine for the treatment of people with mild-to-moderate PCP who are intolerant of cotrimoxazole. We developed a decision tree model to estimate the costs and cost effectiveness of atovaquone therapy compared with intravenous pentamidine therapy for cotrimoxazole-intolerant patients with mild-to-moderate PCP. Clinical outcomes were based on data from a phase III trial comparing the 2 medications. Our economic outcomes were based on treatment algorithms derived from discharge data, published reports and the clinical judgement of the co-authors. We estimate the total expected cost of treating a patient for an episode of PCP with atovaquone to be $US3990 compared with $US6545 for pentamidine under our baseline scenario (1995 dollars). Our decision model also provides insight into the large cost-savings benefits of treating mild-to-moderate PCP on an outpatient basis.
authors.affiliation: Center for Economics Research, Research Triangle Institute, Research Triangle Park, North Carolina, USA.
authors.forename: G A
authors.initials: GA
authors.lastname: Zarkin
authors.forename: M V
authors.initials: MV
authors.lastname: Bala
authors.forename: L L
authors.initials: LL
authors.lastname: Wood
authors.forename: C L
authors.initials: CL
authors.lastname: Bennett
authors.forename: K
authors.initials: K
authors.lastname: Simpson
authors.forename: M N
authors.initials: MN
authors.lastname: Dohn
mesh_terms: D000935:Antifungal Agents / Q000191:economics* / Q000627:therapeutic use; D053626:Atovaquone; D003365:Costs and Cost Analysis; D003663:Decision Trees; D006801:Humans; D007275:Injections, Intravenous; D009010:Monte Carlo Method; D009285:Naphthoquinones / Q000191:economics* / Q000627:therapeutic use; D010419:Pentamidine / Q000191:economics* / Q000627:therapeutic use; D011020:Pneumonia, Pneumocystis / Q000188:drug therapy* / Q000191:economics*