795 Primary Prophylaxis Against Systemic Fungal Infections Among Persons Living with AIDS in Thailand: A Cost-effectiveness Analysis K. Tuli*1,2, T. Clark1, P. Ningsanond3, J. Morgan1, Y. Laosiritaworn3, S. Kongsin4, S. Thanprasertsuk5, J. Tappero5, R. Hajjeh1 1CDC, Atlanta, GA; 2Los Angeles County STD Prgm, CA; 3Intl Field Epidemiology Training Program, Thailand; 4Mahidol Univ, Bangkok, Thailand; and 5Thailand MOPH-U S CDC Collaboration, Nonthaburi
Background: Systemic fungal opportunistic infections (SFOIs) are common among persons living with AIDS (PLAs) in Thailand. Fluconazole and itraconazole are effective in preventing them. The objective of this study was to assess the cost-effectiveness (CE) of primary prophylaxis against SFOIs among PLAs in Thailand.
Methods: The CE analysis employed a societal perspective, was incremental, and compared 3 strategies: no primary SFOI prophylaxis, fluconazole (400 mg weekly), and itraconazole (200 mg daily). The occurrence of OIs among PLAs with CD4 counts below 200/mm3 was simulated with a Markov model. Epidemiological and cost parameters were obtained from the literature. In the base case, the annual incidence of SFOI was 19% (without prophylaxis); efficacy of primary prophylaxis was 70% for fluconazole and 90% for itraconazole; weekly cost was US$0.28 for fluconazole and US$11.56 for itraconazole; and costs and effects were discounted by 3% annually.
Results: Discounted life expectancy and costs (per person) for the 3 strategies were as follows: 11.4 mos, US$543 (no prophylaxis); 11.62 mos, US$519 (fluconazole); and 11.69 mos, US$1,046 (itraconazole). Compared to no prophylaxis, fluconazole prophylaxis was cost-saving. Prophylaxis costs were more than offset by savings due to prevention of SFOIs. It remained cost saving at a weekly fluconazole cost of less than US$1.26. Compared to fluconazole, itraconazole prophylaxis cost approximately US$88,000 per additional life year saved.
Conclusions: The study supports the government recommendation for primary fluconazole prophylaxis for PLAs in Thailand. Fluconazole prophylaxis may also be cost-effective in other countries with large AIDS epidemics and high incidence of fungal OIs.
