{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,26]],"date-time":"2026-09-26T09:00:47Z","timestamp":1790413247726,"version":"4.1.0"},"reference-count":17,"publisher":"Oxford University Press (OUP)","issue":"1","license":[{"start":{"date-parts":[[2019,2,28]],"date-time":"2019-02-28T00:00:00Z","timestamp":1551312000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000265","name":"Medical Research Council","doi-asserted-by":"publisher","award":["100504"],"award-info":[{"award-number":["100504"]}],"id":[{"id":"10.13039\/501100000265","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000265","name":"Medical Research Council","doi-asserted-by":"publisher","award":["ANRS12275"],"award-info":[{"award-number":["ANRS12275"]}],"id":[{"id":"10.13039\/501100000265","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2020,1,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Mortality from cryptococcal meningitis remains very high in Africa. In the Advancing Cryptococcal Meningitis Treatment for Africa (ACTA) trial, 2 weeks of fluconazole (FLU) plus flucytosine (5FC) was as effective and less costly than 2 weeks of amphotericin-based regimens. However, many African settings treat with FLU monotherapy, and the cost-effectiveness of adding 5FC to FLU is uncertain.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>The effectiveness and costs of FLU+5FC were taken from ACTA, which included a costing analysis at the Zambian site. The effectiveness of FLU was derived from cohorts of consecutively enrolled patients, managed in respects other than drug therapy, as were participants in ACTA. FLU costs were derived from costs of FLU+5FC in ACTA, by subtracting 5FC drug and monitoring costs. The cost-effectiveness of FLU+5FC vs FLU alone was measured as the incremental cost-effectiveness ratio (ICER). A probabilistic sensitivity analysis assessed uncertainties and a bivariate deterministic sensitivity analysis examined the impact of varying mortality and 5FC drug costs on the ICER.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>The mean costs per patient were US $847 (95% confidence interval [CI] $776\u2013927) for FLU+5FC, and US $628 (95% CI $557\u2013709) for FLU. The 10-week mortality rate was 35.1% (95% CI 28.9\u201341.7%) with FLU+5FC and 53.8% (95% CI 43.1\u201364.1%) with FLU. At the current 5FC price of US $1.30 per 500 mg tablet, the ICER of 5FC+FLU versus FLU alone was US $65 (95% CI $28\u2013208) per life-year saved. Reducing the 5FC cost to between US $0.80 and US $0.40 per 500 mg resulted in an ICER between US $44 and US $28 per life-year saved.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>The addition of 5FC to FLU is cost-effective for cryptococcal meningitis treatment in Africa and, if made available widely, could substantially reduce mortality rates among human immunodeficiency virus\u2013infected persons in Africa.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/cid\/ciz163","type":"journal-article","created":{"date-parts":[[2019,2,22]],"date-time":"2019-02-22T15:19:14Z","timestamp":1550848754000},"page":"26-29","source":"Crossref","is-referenced-by-count":16,"title":["Addition of Flucytosine to Fluconazole for the Treatment of Cryptococcal Meningitis in Africa: A Multicountry Cost-effectiveness Analysis"],"prefix":"10.1093","volume":"70","author":[{"given":"Tinevimbo","family":"Shiri","sequence":"first","affiliation":[{"name":"Liverpool School of Tropical Medicine, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Angela","family":"Loyse","sequence":"additional","affiliation":[{"name":"Centre for Global Health, Institute for Infection and Immunity, St George\u2019s University of London, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lawrence","family":"Mwenge","sequence":"additional","affiliation":[{"name":"Zambart, Health Economics Unit, Lusaka, Zambia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tao","family":"Chen","sequence":"additional","affiliation":[{"name":"Liverpool School of Tropical Medicine, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shabir","family":"Lakhi","sequence":"additional","affiliation":[{"name":"University Teaching Hospital, Lusaka, Lusaka, Zambia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Duncan","family":"Chanda","sequence":"additional","affiliation":[{"name":"University Teaching Hospital, Lusaka, Lusaka, Zambia"},{"name":"Institute for Medical Research and Training, University Teaching Hospital, Lusaka, Zambia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter","family":"Mwaba","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine and Directorate of Research and Post-graduate Studies, Lusaka Apex Medical University, Zambia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S\u00edle F","family":"Molloy","sequence":"additional","affiliation":[{"name":"Centre for Global Health, Institute for Infection and Immunity, St George\u2019s University of London, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert S","family":"Heyderman","sequence":"additional","affiliation":[{"name":"Malawi-Liverpool-Wellcome Trust Clinical Research Programme, University of Malawi, Blantyre"},{"name":"College of Medicine, University of Malawi, Blantyre"},{"name":"University College London, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cecilia","family":"Kanyama","sequence":"additional","affiliation":[{"name":"University of North Carolina Project-Malawi, Kamuzu Central Hospital, Lilongwe, Malawi"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mina C","family":"Hosseinipour","sequence":"additional","affiliation":[{"name":"University of North Carolina Project-Malawi, Kamuzu Central Hospital, Lilongwe, Malawi"},{"name":"Division of Infectious Diseases, University of North Carolina at Chapel Hill School of Medicine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Charles","family":"Kouanfack","sequence":"additional","affiliation":[{"name":"H\u00f4pital Central Yaounde\u0301\/Site Agence Nationale de Recherche sur le Sida Cameroun, Cameroon"},{"name":"University of Dschang, Cameroon"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elvis","family":"Temfack","sequence":"additional","affiliation":[{"name":"Douala General Hospital, Cameroon"},{"name":"Institut Pasteur, Molecular Mycology Unit, National Reference Center for Invasive Mycoses & Antifungals, Centre National de la Recherche Scientifique, Paris, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sayoki","family":"Mfinanga","sequence":"additional","affiliation":[{"name":"Liverpool School of Tropical Medicine, United Kingdom"},{"name":"National Institute for Medical Research, Muhimbili Medical Research Centre, Dar Es Salaam, United Republic of Tanzania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sokoine","family":"Kivuyo","sequence":"additional","affiliation":[{"name":"National Institute for Medical Research, Muhimbili Medical Research Centre, Dar Es Salaam, United Republic of Tanzania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adrienne K","family":"Chan","sequence":"additional","affiliation":[{"name":"Dignitas International, Zomba Central Hospital, Malawi"},{"name":"Division of Infectious Diseases, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joseph N","family":"Jarvis","sequence":"additional","affiliation":[{"name":"Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, United Kingdom"},{"name":"Botswana Harvard AIDS Institute Partnership, Gabarone"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Olivier","family":"Lortholary","sequence":"additional","affiliation":[{"name":"Institut Pasteur, Molecular Mycology Unit, National Reference Center for Invasive Mycoses & Antifungals, Centre National de la Recherche Scientifique, Paris, France"},{"name":"Paris Descartes University, Necker Pasteur Center for Infectious Diseases and Tropical Medicine, Institut Hospitalo-Universitaire Imagine, Assistance Publique - H\u00f4pitaux de Paris, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shabbar","family":"Jaffar","sequence":"additional","affiliation":[{"name":"Liverpool School of Tropical Medicine, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Louis W","family":"Niessen","sequence":"additional","affiliation":[{"name":"Liverpool School of Tropical Medicine, United Kingdom"},{"name":"Department of International Health, Johns Hopkins School of Public Health, Baltimore, Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3619-4348","authenticated-orcid":false,"given":"Thomas S","family":"Harrison","sequence":"additional","affiliation":[{"name":"Centre for Global Health, Institute for Infection and Immunity, St George\u2019s University of London, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2019,2,28]]},"reference":[{"key":"2019121604173503600_CIT0001","doi-asserted-by":"crossref","first-page":"873","DOI":"10.1016\/S1473-3099(17)30243-8","article-title":"Global burden of disease of HIV-associated cryptococcal meningitis: an updated analysis","volume":"17","author":"Rajasingham","year":"2017","journal-title":"Lancet Infect Dis"},{"key":"2019121604173503600_CIT0002","doi-asserted-by":"crossref","first-page":"e110285","DOI":"10.1371\/journal.pone.0110285","article-title":"A prospective study of mortality from 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