@article{Lawrence2022,
abstract = {Summary Background HIV-associated cryptococcal meningitis is a leading cause of AIDS-related mortality. The AMBITION-cm trial showed that a regimen based on a single high dose of liposomal amphotericin B deoxycholate (AmBisome group) was non-inferior to the WHO-recommended treatment of seven daily doses of amphotericin B deoxycholate (control group) and was associated with fewer adverse events. We present a five-country cost-effectiveness analysis. Methods The AMBITION-cm trial enrolled patients with HIV-associated cryptococcal meningitis from eight hospitals in Botswana, Malawi, South Africa, Uganda, and Zimbabwe. Taking a health service perspective, we collected country-specific unit costs and individual resource-use data per participant over the 10-week trial period, calculating mean cost per participant by group, mean cost-difference between groups, and incremental cost-effectiveness ratio per life-year saved. Non-parametric bootstrapping and scenarios analyses were performed including hypothetical real-world resource use. The trial registration number is ISRCTN72509687, and the trial has been completed. Findings The AMBITION-cm trial enrolled 844 participants, and 814 were included in the intention-to-treat analysis (327 from Uganda, 225 from Malawi, 107 from South Africa, 84 from Botswana, and 71 from Zimbabwe) with 407 in each group, between Jan 31, 2018, and Feb 17, 2021. Using Malawi as a representative example, mean total costs per participant were US{\$}1369 (95{\%} CI 1314–1424) in the AmBisome group and {\$}1237 (1181–1293) in the control group. The incremental cost-effectiveness ratio was {\$}128 (59–257) per life-year saved. Excluding study protocol-driven cost, using a real-world toxicity monitoring schedule, the cost per life-year saved reduced to {\$}80 (15–275). Changes in the duration of the hospital stay and antifungal medication cost showed the greatest effect in sensitivity analyses. Results were similar across countries, with the cost per life-year saved in the real-world scenario ranging from {\$}71 in Botswana to {\$}121 in Uganda. Interpretation The AmBisome regimen was cost-effective at a low incremental cost-effectiveness ratio. The regimen might be even less costly and potentially cost-saving in real-world implementation given the lower drug-related toxicity and the potential for shorter hospital stays. Funding European Developing Countries Clinical Trials Partnership, Swedish International Development Cooperation Agency, Wellcome Trust and Medical Research Council, UKAID Joint Global Health Trials, and the National Institute for Health Research. Translations For the Chichewa, Isixhosa, Luganda, Setswana and Shona translations of the abstract see Supplementary Materials section.},
author = {Lawrence, David S and Muthoga, Charles and Meya, David B and Tugume, Lillian and Williams, Darlisha and Rajasingham, Radha and Boulware, David R and Mwandumba, Henry C and Moyo, Melanie and Dziwani, Eltas N and Maheswaran, Hendramoorthy and Kanyama, Cecilia and Hosseinipour, Mina C and Chawinga, Chimwemwe and Meintjes, Graeme and Schutz, Charlotte and Comins, Kyla and Bango, Funeka and Muzoora, Conrad and Jjunju, Samuel and Nuwagira, Edwin and Mosepele, Mosepele and Leeme, Tshepo and Ndhlovu, Chiratidzo E and Hlupeni, Admire and Shamu, Shepherd and Boyer-Chammard, Timoth{\'{e}}e and Molloy, S{\'{i}}le F and Youssouf, Nabila and Chen, Tao and Shiri, Tinevimbo and Jaffar, Shabbar and Harrison, Thomas S and Jarvis, Joseph N and Niessen, Louis W and Goodall, Jack and Lechiile, Kwana and Mawoko, Norah and Mbangiwa, Tshepiso and Milburn, James and Mmipi, Refilwe and Ponatshego, Ponego and Rulaganyang, Ikanyang and Seatla, Kaelo and Siamisang, Keatlaretse and Tlhako, Nametso and Tsholo, Katlego and April, Samantha and Bekiswa, Abulele and Boloko, Linda and Bookholane, Hloni and Crede, Thomas and Davids, Lee-Ann and Goliath, Rene and Hlungulu, Siphokazi and Hoffman, Regina and Kyepa, Henriette and Masina, Noma and Maughan, Deborah and Mnguni, Trevor and Moosa, Sumaiyya and Morar, Tania and Mpalali, Mkanyiseli and Naude, Jonathan and Oliphant, Ida and Singh, Achita and Sayed, Sumaya and Sebesho, Leago and Shey, Muki and Swanepoel, Loraine and Chasweka, Madalitso and Chimang'anga, Wezi and Chimphambano, Tipatseni and Gondwe, Ebbie and Mzinganjira, Henry and Kadzilimbile, Aubrey and Kateta, Steven and Kossam, Evelyn and Kukacha, Christopher and Lipenga, Bright and Ndaferankhande, John and Ndalama, Maureen and Shah, Reya and Singini, Andreas and Stott, Katherine and Zambasa, Agness and Banda, Towera and Chikaonda, Tarsizio and Chitulo, Gladys and Chiwoko, Lorren and Chome, Nelecy and Gwin, Mary and Kachitosi, Timothy and Kamanga, Beauty and Kazembe, Mussah and Kumwenda, Emily and Kumwenda, Masida and Maya, Chimwemwe and Mhango, Wilberforce and Mphande, Chimwemwe and Msumba, Lusungu and Munthali, Tapiwa and Ngoma, Doris and Nicholas, Simon and Simwinga, Lusayo and Stambuli, Anthony and Tegha, Gerald and Zambezi, Janet and Ahimbisibwe, Cynthia and Akampurira, Andrew and Alice, Anamudde and Cresswell, Fiona and Gakuru, Jane and Kagimu, Enock and Kasibante, John and Kiiza, Daniel and Kisembo, John and Kwizera, Richard and Kugonza, Florence and Laker, Eva and Luggya, Tonny and Lule, Andrew and Musubire, Abdu and Muyise, Rhona and Namujju, Carol Olivie and Ndyetukira, Jane Francis and Nsangi, Laura and Okirworth, Michael and Rhein, Joshua and Rutakingirwa, Morris K and Sadiq, Alisat and Ssebambulidde, Kenneth and Tadeo, Kiiza and Tukundane, Asmus and Atwine, Leo and Buzaare, Peter and Collins, Muganzi and Emily, Ninsima and Inyakuwa, Christine and Kariisa, Samson and Mwesigye, James and Nuwamanya, Simpson and Rodgers, Ankunda and Rukundo, Joan and Rwomushana, Irene and Ssemusu, Mike and Stead, Gavin and Boyd, Kathyrn and Gondo, Secrecy and Kufa, Prosper and Makaha, Edward and Moyo, Colombus and Mtisi, Takudzwa and Mudzinga, Shepherd and Mutata, Constantine and Mwarumba, Taddy and Zinyandu, Tawanda and Alanio, Alexandre and Dromer, Francoise and Lortholary, Olivier and Sturny-Leclere, Aude and Griffin, Philippa and Hafeez, Sophia and Loyse, Angela and van Widenfelt, Erik},
doi = {10.1016/S2214-109X(22)00450-8},
file = {:C$\backslash$:/Users/01462563/AppData/Local/Mendeley Ltd./Mendeley Desktop/Downloaded/Lawrence et al. - 2022 - Cost-effectiveness of single, high-dose, liposomal amphotericin regimen for HIV-associated cryptococcal meningi.pdf:pdf},
issn = {2214-109X},
journal = {The Lancet Global Health},
keywords = {OA,fund{\_}ack,original},
mendeley-tags = {OA,fund{\_}ack,original},
month = {dec},
number = {12},
pages = {e1845--e1854},
pmid = {36400090},
publisher = {Elsevier},
title = {{Cost-effectiveness of single, high-dose, liposomal amphotericin regimen for HIV-associated cryptococcal meningitis in five countries in sub-Saharan Africa: an economic analysis of the AMBITION-cm trial}},
url = {http://www.thelancet.com/article/S2214109X22004508/fulltext http://www.thelancet.com/article/S2214109X22004508/abstract https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(22)00450-8/abstract},
volume = {10},
year = {2022}
}

{"_id":"4hbm7esMPutzqTsjK","bibbaseid":"lawrence-muthoga-meya-tugume-williams-rajasingham-boulware-mwandumba-etal-costeffectivenessofsinglehighdoseliposomalamphotericinregimenforhivassociatedcryptococcalmeningitisinfivecountriesinsubsaharanafricaaneconomicanalysisoftheambitioncmtrial-2022","author_short":["Lawrence, D. S","Muthoga, C.","Meya, D. B","Tugume, L.","Williams, D.","Rajasingham, R.","Boulware, D. R","Mwandumba, H. C","Moyo, M.","Dziwani, E. N","Maheswaran, H.","Kanyama, C.","Hosseinipour, M. C","Chawinga, C.","Meintjes, G.","Schutz, C.","Comins, K.","Bango, F.","Muzoora, C.","Jjunju, S.","Nuwagira, E.","Mosepele, M.","Leeme, T.","Ndhlovu, C. E","Hlupeni, A.","Shamu, S.","Boyer-Chammard, T.","Molloy, S. F","Youssouf, N.","Chen, T.","Shiri, T.","Jaffar, S.","Harrison, T. S","Jarvis, J. N","Niessen, L. W","Goodall, J.","Lechiile, K.","Mawoko, N.","Mbangiwa, T.","Milburn, J.","Mmipi, R.","Ponatshego, P.","Rulaganyang, I.","Seatla, K.","Siamisang, K.","Tlhako, N.","Tsholo, K.","April, S.","Bekiswa, A.","Boloko, L.","Bookholane, H.","Crede, T.","Davids, L.","Goliath, R.","Hlungulu, S.","Hoffman, R.","Kyepa, H.","Masina, N.","Maughan, D.","Mnguni, T.","Moosa, S.","Morar, T.","Mpalali, M.","Naude, J.","Oliphant, I.","Singh, A.","Sayed, S.","Sebesho, L.","Shey, M.","Swanepoel, L.","Chasweka, M.","Chimang'anga, W.","Chimphambano, T.","Gondwe, E.","Mzinganjira, H.","Kadzilimbile, A.","Kateta, S.","Kossam, E.","Kukacha, C.","Lipenga, B.","Ndaferankhande, J.","Ndalama, M.","Shah, R.","Singini, A.","Stott, K.","Zambasa, A.","Banda, T.","Chikaonda, T.","Chitulo, G.","Chiwoko, L.","Chome, N.","Gwin, M.","Kachitosi, T.","Kamanga, B.","Kazembe, M.","Kumwenda, E.","Kumwenda, M.","Maya, C.","Mhango, W.","Mphande, C.","Msumba, L.","Munthali, T.","Ngoma, D.","Nicholas, S.","Simwinga, L.","Stambuli, A.","Tegha, G.","Zambezi, J.","Ahimbisibwe, C.","Akampurira, A.","Alice, A.","Cresswell, F.","Gakuru, J.","Kagimu, E.","Kasibante, J.","Kiiza, D.","Kisembo, J.","Kwizera, R.","Kugonza, F.","Laker, E.","Luggya, T.","Lule, A.","Musubire, A.","Muyise, R.","Namujju, C. O.","Ndyetukira, J. F.","Nsangi, L.","Okirworth, M.","Rhein, J.","Rutakingirwa, M. K","Sadiq, A.","Ssebambulidde, K.","Tadeo, K.","Tukundane, A.","Atwine, L.","Buzaare, P.","Collins, M.","Emily, N.","Inyakuwa, C.","Kariisa, S.","Mwesigye, J.","Nuwamanya, S.","Rodgers, A.","Rukundo, J.","Rwomushana, I.","Ssemusu, M.","Stead, G.","Boyd, K.","Gondo, S.","Kufa, P.","Makaha, E.","Moyo, C.","Mtisi, T.","Mudzinga, S.","Mutata, C.","Mwarumba, T.","Zinyandu, T.","Alanio, A.","Dromer, F.","Lortholary, O.","Sturny-Leclere, A.","Griffin, P.","Hafeez, S.","Loyse, A.","van Widenfelt, E."],"bibdata":{"bibtype":"article","type":"article","abstract":"Summary Background HIV-associated cryptococcal meningitis is a leading cause of AIDS-related mortality. The AMBITION-cm trial showed that a regimen based on a single high dose of liposomal amphotericin B deoxycholate (AmBisome group) was non-inferior to the WHO-recommended treatment of seven daily doses of amphotericin B deoxycholate (control group) and was associated with fewer adverse events. We present a five-country cost-effectiveness analysis. Methods The AMBITION-cm trial enrolled patients with HIV-associated cryptococcal meningitis from eight hospitals in Botswana, Malawi, South Africa, Uganda, and Zimbabwe. Taking a health service perspective, we collected country-specific unit costs and individual resource-use data per participant over the 10-week trial period, calculating mean cost per participant by group, mean cost-difference between groups, and incremental cost-effectiveness ratio per life-year saved. Non-parametric bootstrapping and scenarios analyses were performed including hypothetical real-world resource use. The trial registration number is ISRCTN72509687, and the trial has been completed. Findings The AMBITION-cm trial enrolled 844 participants, and 814 were included in the intention-to-treat analysis (327 from Uganda, 225 from Malawi, 107 from South Africa, 84 from Botswana, and 71 from Zimbabwe) with 407 in each group, between Jan 31, 2018, and Feb 17, 2021. Using Malawi as a representative example, mean total costs per participant were US$}1369 (95{%} CI 1314–1424) in the AmBisome group and {$1237 (1181–1293) in the control group. The incremental cost-effectiveness ratio was $}128 (59–257) per life-year saved. Excluding study protocol-driven cost, using a real-world toxicity monitoring schedule, the cost per life-year saved reduced to {$80 (15–275). Changes in the duration of the hospital stay and antifungal medication cost showed the greatest effect in sensitivity analyses. Results were similar across countries, with the cost per life-year saved in the real-world scenario ranging from $}71 in Botswana to {$121 in Uganda. Interpretation The AmBisome regimen was cost-effective at a low incremental cost-effectiveness ratio. The regimen might be even less costly and potentially cost-saving in real-world implementation given the lower drug-related toxicity and the potential for shorter hospital stays. Funding European Developing Countries Clinical Trials Partnership, Swedish International Development Cooperation Agency, Wellcome Trust and Medical Research Council, UKAID Joint Global Health Trials, and the National Institute for Health Research. Translations For the Chichewa, Isixhosa, Luganda, Setswana and Shona translations of the abstract see Supplementary Materials 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Ltd./Mendeley Desktop/Downloaded/Lawrence et al. - 2022 - Cost-effectiveness of single, high-dose, liposomal amphotericin regimen for HIV-associated cryptococcal meningi.pdf:pdf","issn":"2214-109X","journal":"The Lancet Global Health","keywords":"OA,fund_ack,original","mendeley-tags":"OA,fund_ack,original","month":"dec","number":"12","pages":"e1845–e1854","pmid":"36400090","publisher":"Elsevier","title":"Cost-effectiveness of single, high-dose, liposomal amphotericin regimen for HIV-associated cryptococcal meningitis in five countries in sub-Saharan Africa: an economic analysis of the AMBITION-cm trial","url":"http://www.thelancet.com/article/S2214109X22004508/fulltext http://www.thelancet.com/article/S2214109X22004508/abstract https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(22)00450-8/abstract","volume":"10","year":"2022","bibtex":"@article{Lawrence2022,\r\nabstract = {Summary Background HIV-associated cryptococcal meningitis is a leading cause of AIDS-related mortality. The AMBITION-cm trial showed that a regimen based on a single high dose of liposomal amphotericin B deoxycholate (AmBisome group) was non-inferior to the WHO-recommended treatment of seven daily doses of amphotericin B deoxycholate (control group) and was associated with fewer adverse events. We present a five-country cost-effectiveness analysis. Methods The AMBITION-cm trial enrolled patients with HIV-associated cryptococcal meningitis from eight hospitals in Botswana, Malawi, South Africa, Uganda, and Zimbabwe. Taking a health service perspective, we collected country-specific unit costs and individual resource-use data per participant over the 10-week trial period, calculating mean cost per participant by group, mean cost-difference between groups, and incremental cost-effectiveness ratio per life-year saved. Non-parametric bootstrapping and scenarios analyses were performed including hypothetical real-world resource use. The trial registration number is ISRCTN72509687, and the trial has been completed. Findings The AMBITION-cm trial enrolled 844 participants, and 814 were included in the intention-to-treat analysis (327 from Uganda, 225 from Malawi, 107 from South Africa, 84 from Botswana, and 71 from Zimbabwe) with 407 in each group, between Jan 31, 2018, and Feb 17, 2021. Using Malawi as a representative example, mean total costs per participant were US{\\$}1369 (95{\\%} CI 1314–1424) in the AmBisome group and {\\$}1237 (1181–1293) in the control group. The incremental cost-effectiveness ratio was {\\$}128 (59–257) per life-year saved. Excluding study protocol-driven cost, using a real-world toxicity monitoring schedule, the cost per life-year saved reduced to {\\$}80 (15–275). Changes in the duration of the hospital stay and antifungal medication cost showed the greatest effect in sensitivity analyses. Results were similar across countries, with the cost per life-year saved in the real-world scenario ranging from {\\$}71 in Botswana to {\\$}121 in Uganda. Interpretation The AmBisome regimen was cost-effective at a low incremental cost-effectiveness ratio. The regimen might be even less costly and potentially cost-saving in real-world implementation given the lower drug-related toxicity and the potential for shorter hospital stays. Funding European Developing Countries Clinical Trials Partnership, Swedish International Development Cooperation Agency, Wellcome Trust and Medical Research Council, UKAID Joint Global Health Trials, and the National Institute for Health Research. Translations For the Chichewa, Isixhosa, Luganda, Setswana and Shona translations of the abstract see Supplementary Materials section.},\r\nauthor = {Lawrence, David S and Muthoga, Charles and Meya, David B and Tugume, Lillian and Williams, Darlisha and Rajasingham, Radha and Boulware, David R and Mwandumba, Henry C and Moyo, Melanie and Dziwani, Eltas N and Maheswaran, Hendramoorthy and Kanyama, Cecilia and Hosseinipour, Mina C and Chawinga, Chimwemwe and Meintjes, Graeme and Schutz, Charlotte and Comins, Kyla and Bango, Funeka and Muzoora, Conrad and Jjunju, Samuel and Nuwagira, Edwin and Mosepele, Mosepele and Leeme, Tshepo and Ndhlovu, Chiratidzo E and Hlupeni, Admire and Shamu, Shepherd and Boyer-Chammard, Timoth{\\'{e}}e and Molloy, S{\\'{i}}le F and Youssouf, Nabila and Chen, Tao and Shiri, Tinevimbo and Jaffar, Shabbar and Harrison, Thomas S and Jarvis, Joseph N and Niessen, Louis W and Goodall, Jack and Lechiile, Kwana and Mawoko, Norah and Mbangiwa, Tshepiso and Milburn, James and Mmipi, Refilwe and Ponatshego, Ponego and Rulaganyang, Ikanyang and Seatla, Kaelo and Siamisang, Keatlaretse and Tlhako, Nametso and Tsholo, Katlego and April, Samantha and Bekiswa, Abulele and Boloko, Linda and Bookholane, Hloni and Crede, Thomas and Davids, Lee-Ann and Goliath, Rene and Hlungulu, Siphokazi and Hoffman, Regina and Kyepa, Henriette and Masina, Noma and Maughan, Deborah and Mnguni, Trevor and Moosa, Sumaiyya and Morar, Tania and Mpalali, Mkanyiseli and Naude, Jonathan and Oliphant, Ida and Singh, Achita and Sayed, Sumaya and Sebesho, Leago and Shey, Muki and Swanepoel, Loraine and Chasweka, Madalitso and Chimang'anga, Wezi and Chimphambano, Tipatseni and Gondwe, Ebbie and Mzinganjira, Henry and Kadzilimbile, Aubrey and Kateta, Steven and Kossam, Evelyn and Kukacha, Christopher and Lipenga, Bright and Ndaferankhande, John and Ndalama, Maureen and Shah, Reya and Singini, Andreas and Stott, Katherine and Zambasa, Agness and Banda, Towera and Chikaonda, Tarsizio and Chitulo, Gladys and Chiwoko, Lorren and Chome, Nelecy and Gwin, Mary and Kachitosi, Timothy and Kamanga, Beauty and Kazembe, Mussah and Kumwenda, Emily and Kumwenda, Masida and Maya, Chimwemwe and Mhango, Wilberforce and Mphande, Chimwemwe and Msumba, Lusungu and Munthali, Tapiwa and Ngoma, Doris and Nicholas, Simon and Simwinga, Lusayo and Stambuli, Anthony and Tegha, Gerald and Zambezi, Janet and Ahimbisibwe, Cynthia and Akampurira, Andrew and Alice, Anamudde and Cresswell, Fiona and Gakuru, Jane and Kagimu, Enock and Kasibante, John and Kiiza, Daniel and Kisembo, John and Kwizera, Richard and Kugonza, Florence and Laker, Eva and Luggya, Tonny and Lule, Andrew and Musubire, Abdu and Muyise, Rhona and Namujju, Carol Olivie and Ndyetukira, Jane Francis and Nsangi, Laura and Okirworth, Michael and Rhein, Joshua and Rutakingirwa, Morris K and Sadiq, Alisat and Ssebambulidde, Kenneth and Tadeo, Kiiza and Tukundane, Asmus and Atwine, Leo and Buzaare, Peter and Collins, Muganzi and Emily, Ninsima and Inyakuwa, Christine and Kariisa, Samson and Mwesigye, James and Nuwamanya, Simpson and Rodgers, Ankunda and Rukundo, Joan and Rwomushana, Irene and Ssemusu, Mike and Stead, Gavin and Boyd, Kathyrn and Gondo, Secrecy and Kufa, Prosper and Makaha, Edward and Moyo, Colombus and Mtisi, Takudzwa and Mudzinga, Shepherd and Mutata, Constantine and Mwarumba, Taddy and Zinyandu, Tawanda and Alanio, Alexandre and Dromer, Francoise and Lortholary, Olivier and Sturny-Leclere, Aude and Griffin, Philippa and Hafeez, Sophia and Loyse, Angela and van Widenfelt, Erik},\r\ndoi = {10.1016/S2214-109X(22)00450-8},\r\nfile = {:C$\\backslash$:/Users/01462563/AppData/Local/Mendeley Ltd./Mendeley Desktop/Downloaded/Lawrence et al. - 2022 - Cost-effectiveness of single, high-dose, liposomal amphotericin regimen for HIV-associated cryptococcal meningi.pdf:pdf},\r\nissn = {2214-109X},\r\njournal = {The Lancet Global Health},\r\nkeywords = {OA,fund{\\_}ack,original},\r\nmendeley-tags = {OA,fund{\\_}ack,original},\r\nmonth = {dec},\r\nnumber = {12},\r\npages = {e1845--e1854},\r\npmid = {36400090},\r\npublisher = {Elsevier},\r\ntitle = {{Cost-effectiveness of single, high-dose, liposomal amphotericin regimen for HIV-associated cryptococcal meningitis in five countries in sub-Saharan Africa: an economic analysis of the AMBITION-cm trial}},\r\nurl = {http://www.thelancet.com/article/S2214109X22004508/fulltext http://www.thelancet.com/article/S2214109X22004508/abstract https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(22)00450-8/abstract},\r\nvolume = {10},\r\nyear = {2022}\r\n}\r\n","author_short":["Lawrence, D. 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