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Abstract Background Talaromycosis (penicilliosis) is an invasive fungal infection and a major cause of HIV-related deaths in Southeast Asia. Guidelines recommend induction therapy with amphotericin B deoxycholate, however treatment with itraconazole has fewer toxic effects, is easier to administer and is less expensive. Our recent randomized controlled trial in Vietnam found amphotericin B was superior to itraconazole with respect to six-month mortality. We undertook an economic evaluation alongside this trial to determine whether the more effective treatment is cost-effective. Methods Resource use, direct and indirect costs, health and quality of life outcomes (measured using quality-adjusted life-years; QALYs) were evaluated for 405 trial participants from 2012 to 2016. Both a Vietnamese health service and a broader societal costing perspective were considered. Mean costs and QALYs were combined to calculate the within-trial cost-effectiveness of amphotericin versus itraconazole from both perspectives. Results From a Vietnamese health service perspective, amphotericin increases costs but improves health outcomes compared to itraconazole, at a cost of $3,013/QALY gained. The probability that amphotericin is cost-effective at a conventional (WHO-CHOICE) threshold of value for money is 46%. From a societal perspective, amphotericin is cost-reducing and improves outcomes compared to itraconazole, and is likely to be a cost-effective strategy at any value for money threshold greater than $0. Conclusions Our analysis indicates that induction therapy with amphotericin is a cost-effective treatment strategy for HIV-infected adults diagnosed with talaromycosis in Vietnam. These results provide the evidence base for healthcare providers and policy makers to improve access to and use of amphotericin.

Original publication





Open Forum Infectious Diseases


Oxford University Press (OUP)

Publication Date