The Cost-Effectiveness of Fluconazole Prophylaxis against Primary Systemic Fungal Infections in AIDS Patients

Publisher Website
Google Scholar
Abstract
Objective. To project the cost-effectiveness of fluconazole for prophylaxis against AIDS-related primary systemic fungal infections. Design. A Markov model with data from the literature. Patients. Hypothetical cohort of 100,000 AIDS patients. Intervention. No prophylaxis, and fluconazole prophylaxis beginning when a patient's CD4 count declined to below 200/mm3, below 100/mm 3, or below 50/mm3. Results. The no-pro phylaxis policy was associated with a discounted life expectancy of 28.20 months and direct medical costs of $36,100 per person. The 3 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 3 policies, the intermediate alternatives were less economically efficient. A reduction in flucona zole's cost from $206 to $80 decreased the ratio to $50,000 for the 3 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. Key words: fluconazole; prophylaxis; AIDS; cost-effectiveness; Markov model. (Med Decis Making 1997;17: 373-381)