Summary
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 SUS3990 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.
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Zarkin, G.A., Bala, M.V., Wood, L.L. et al. Estimating the Cost Effectiveness of Atovaquone versus Intravenous Pentamidine in the Treatment of Mild-to-Moderate Pneumocystis carinii Pneumonia. Pharmacoeconomics 9, 525–534 (1996). https://doi.org/10.2165/00019053-199609060-00007
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DOI: https://doi.org/10.2165/00019053-199609060-00007