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Cost and benefit of secondary prophylaxis for Pneumocystis carinii pneumonia



Cost and benefit of secondary prophylaxis for Pneumocystis carinii pneumonia



JAMA 266(6): 820-824



Objective: To determine the relative cost and benefit of aerosolized pentamidine and the combination product of sulfamethoxazole and trimethoprin sulfate as secondary prophylaxis for Pneumocystis carinii pneumonia. Design: A Markov-based cost-benefit analysis was performed. Drug efficacies, toxicities, and mortality rates were drawn from the current literature. Setting: Hypothetical. Patient Population: Patients infected with the human immunodeficiency virus who had at least one episode of P. carinii pneumonia. Interventions: Regimen 1 required the use of aerosolized pentamidine as the sole first-line prophylactic agent in all patients. Regimen 2 required the use of sulfamethyoxazole-trimethoprim in all patients who had no history of a toxic reaction to the drug; only patients with a history of toxic effects and those who developed toxic effects while receiving the drug would receive aerosolized pentamidine. Regimen 3 required that no secondary prophylaxis be given. Main Outcome Measures: Net cost, median patient survival, and 5-year survival for each regimen and for regimens 1 and 2 compared with regimen 3. Main Results: Regimen 2 was dominant, with a net cost of S6332 per patient and a median survival of 2.050 years. Compared with no prophylaxis, regimen 2 resulted in a savings of $16,503 per patient and a 0.696-year increase in median survival. Compared with regimen 1, regimen 2 resulted in a savings of S2904 and a 0.067-year increase in median survival. Conclusions: Secondary prophylaxis for P. carinii saves money and extends survival. Current data suggest that sulfamethoxazole-trimethoprim should be given whenever it can be tolerated. Use of aerosolized pentamidine as a first-line agent would result in a modest increase in cost and a decrease in life expectancy.

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Accession: 007165510

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PMID: 1907671

DOI: 10.1001/jama.1991.03470060082031


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