Buchanan, JamesAltunkaya, JamesVan Kinh, NguyenVan Vinh Chau, NguyenTrieu Ly, VoThi Thanh Thuy, PhamHai Vinh, VuThi Hong Hanh, DoanThuy Hang, NguyenPhuong Thuy, Tranvan Doorn, RogierThwaites, GuyGray, AlastairLe, Thuy2021-08-182021-08-182021-07-052328-89572328-8957https://hdl.handle.net/10161/23596<h4>Background</h4>Talaromycosis (penicilliosis) is an invasive fungal infection and a major cause of human immunodeficiency virus (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 that amphotericin B was superior to itraconazole with respect to 6-month mortality. We undertook an economic evaluation alongside this trial to determine whether the more effective treatment is cost-effective.<h4>Methods</h4>Resource use, direct and indirect costs, and 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 vs itraconazole from both perspectives.<h4>Results</h4>From a Vietnamese health service perspective, amphotericin increases costs but improves health outcomes compared to itraconazole, at a cost of $3013/QALY gained. The probability that amphotericin is cost-effective at a conventional (World Health Organization 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.<h4>Conclusions</h4>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 health care providers and policy makers to improve access to and use of amphotericin.HIVamphotericin Bcost-effectivenessitraconazoletalaromycosisJournal article2021-08-18