The extra cost to save 1 in 5 deaths from cryptococcal meningitis in AIDS is $973 according to Tinevimbo Shiri and colleagues. Using data from the ACTA trial, and assuming 14 days dual therapy with fluconazole and flucytosine, mortality falls from 53.8% to 35.1% over 10 weeks, and more over the following weeks. The additional cost per person to deliver this is $65, assuming a price of $1.30 per 500mg tablet of flucytosine.
Scaled up to all 223,100 patients with cryptococcal meningitis globally, the cost would be $40,604,200. If widely adopted, 41,720 people would be saved from dying acutely of cryptococcal meningitis (nearly 20%). This translates globally into $973, or $65 per life year saved.
As the authors point out, reduction of the cost of flucytosine, which would be possible if used on this scale, would bring the total cost down substantially, possibly as low as $0.50 or $15.6 million.
“This study provides further, strong health economic evidence supporting the urgent need to make flucytosine widely available to reduce cryptococcal meningitis mortality in resource-limited settings.”
Professor Thomas Harrison of St George’s University of London ( Senior author on the study and GAFFI Senior Advisor)
‘It is really astonishing that flucytosine availability has not already been widely implemented across Africa and other countries with significant HIV burdens. Flucytosine is a 50 year old antifungal, has been on the WHO Essential Medicines list since 2013, has WHO pre-qualification status, has been known to be very effective in cryptococcal meningitis since 1997, a finding confirmed multiple times since. Now is the time for the Global Fund for AIDS, Tuberculosis and Malaria and national governments to act.”
Professor David Denning, GAFFI’s Chief Executive