The Challenges and Possibilities of Reducing Deaths from Cryptococcal Meningitis in Sub-Saharan Africa

Andrew W K Farlow

doi:10.1371/journal.pmed.1001318

Abstract

Andrew Farlow reflects on new research by David Boulware and colleagues, highlighting current challenges in treating cryptoccocal meningitis and the relative neglect of investment in research to treat this disease.

Highlights

With increased access to life-saving drugs, HIV is becoming less of a death sentence in developing countries
All six cryptococcal meningitis (CM) regimens generate costs per quality-adjusted lifeyear (QALY) gained that are well below the level used by the World Health Organization (WHO) to define an intervention as ‘‘highly cost-effective’’
This Perspective discusses the following new study published in PLOS Medicine: Rajasingham R, Rolfes MA, Birkenkamp KE, Meya DB, Boulware DR (2012) Cryptococcal Meningitis Treatment Strategies in Resource-Limited Settings: A Cost-Effectiveness Analysis

Summary

Linked Research Article

This Perspective discusses the following new study published in PLOS Medicine: Rajasingham R, Rolfes MA, Birkenkamp KE, Meya DB, Boulware DR (2012) Cryptococcal Meningitis Treatment Strategies in Resource-Limited Settings: A Cost-Effectiveness Analysis. One treatment regimen might be superior to others in terms of QALYs gained, but QALYs accumulate over many years, whereas a change in practice may come up against a hard budget constraint in the here and ; the short-course amphotericin-based regimen achieves the lowest cost per QALY gained because of its superior survival rates, but it is still US$60 more expensive per patient than fluconazole monotherapy. Given that fluconazole monotherapy is ‘‘highly cost-effective’’, the relative inertia of policy-makers and funders in making other drugs available may have inadvertently made it the only regimen available in many resource-poor settings. PLOS Medicine | www.plosmedicine.org needs at least to be combined with amphotericin if reliance on it is not to be detrimental

Proposed Research Strategy

Findings

Author Contributions