title: Primary prophylaxis of disseminated histoplasmosis in HIV patients in French Guiana: arguments for cost effectiveness.
abstract: Histoplasmosis is the first cause of acquired immunodeficiency syndrome (AIDS) and AIDS-related deaths in French Guiana. Cohort data were used to determine whether primary prophylaxis with 100 mg itraconazole for patients with CD4 counts < 150/mm(3) was cost-effective with different scenarios. For a scenario where 12% of patients died, 60% were aware of their human immunodeficiency virus (HIV) infection and adherence was only 50%, primary prophylaxis would prevent 1 death and 9 cases of histoplasmosis for a cost of 36,792 Euros per averted death, 1,533 per life-year saved, 4,415 Euros per averted case, when only counting the costs of itraconazole prophylaxis. Taking into account the total costs of hospitalization showed that primary prophylaxis would allow a savings of 185,178 Euros per year. Even in a scenario of low adherence, primary prophylaxis would be cost-effective in French Guiana, and presumably in the rest of the Guianas and the Amazon.
authors.affiliation: Centre d'Investigation Clinique Epidémiologie Clinique Antilles Guyane (Inserm/DGOS CIE 802), Centre Hospitalier de Cayenne, French Guiana; Epidemiologie Parasitoses et Mycoses Tropicales, EA 3593, Université Antilles Guyane, Cayenne, French Guiana; Coordination Regionale de lutte contre le VIH, Centre Hospitalier de Cayenne, French Guiana; Centre Hospitalier de l'Ouest Guyanais, Saint Laurent du Maroni, French Guiana; Laboratoire Hospitalo Universitaire de Parasitologie Mycologie, Centre Hospitalier de Cayenne, French Guiana; Service de Dermatologie, Centre Hospitalier de Cayenne, French Guiana.
authors.forename: Mathieu
authors.initials: M
authors.lastname: Nacher
authors.forename: Antoine
authors.initials: A
authors.lastname: Adenis
authors.forename: Celia
authors.initials: C
authors.lastname: Basurko
authors.forename: Vincent
authors.initials: V
authors.lastname: Vantilcke
authors.forename: Denis
authors.initials: D
authors.lastname: Blanchet
authors.forename: Christine
authors.initials: C
authors.lastname: Aznar
authors.forename: Bernard
authors.initials: B
authors.lastname: Carme
authors.forename: Pierre
authors.initials: P
authors.lastname: Couppié
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000150:complications / Q000191:economics / Q000401:mortality / Q000517:prevention & control*; D000935:Antifungal Agents / Q000008:administration & dosage / Q000191:economics*; D015331:Cohort Studies; D003362:Cost-Benefit Analysis; D005260:Female; D005616:French Guiana / Q000453:epidemiology; D015658:HIV Infections / Q000150:complications* / Q000191:economics / Q000401:mortality; D006660:Histoplasmosis / Q000150:complications / Q000191:economics / Q000401:mortality / Q000517:prevention & control*; D006760:Hospitalization / Q000191:economics; D006801:Humans; D016867:Immunocompromised Host; D015994:Incidence; D017964:Itraconazole / Q000008:administration & dosage / Q000191:economics*; D008297:Male
chemical_list: D000935:Antifungal Agents; D017964:Itraconazole