The most effective treatment for advanced AIDS-associated Kaposi sarcoma is paclitaxel or pegylated liposomal doxorubicin (PLD); neither is routinely used in sub-Saharan Africa due to limited availability and high cost. We examined the clinical impact, costs, and cost-effectiveness of paclitaxel or PLD in Kenya, compared with etoposide or bleomycin–vincristine. In this study, we use the Cost-Effectiveness of Preventing AIDS Complications (CEPAC)—International Model to project clinical outcomes and costs among people living with HIV and advanced Kaposi sarcoma on antiretroviral therapy. We compared four different treatment strategies: etoposide, bleomycin–vincristine, paclitaxel, or PLD. We derived cohort characteristics and costs from the Kenyan Academic Model for Providing Access to Healthcare network, and adverse events, efficacy, and mortality from clinical trials. We projected model outcomes over a lifetime and included life expectancy, per-person lifetime costs, and incremental cost-effectiveness ratios (ICERs). We conducted budget impact analysis for 5-year total costs and did deterministic and probabilistic sensitivity analyses to evaluate the effect of uncertainty in input parameters. We found that paclitaxel would be more effective than bleomycin–vincristine and would increase life expectancy by 4·2 years per person. PLD would further increase life expectancy by 0·6 years per person. Paclitaxel would be the most cost-effective strategy (ICER US$380 per year-of-life-saved compared with bleomycin–vincristine) and would remain cost-effective across a range of scenarios. PLD would be cost-effective compared with paclitaxel if its price were reduced to $100 per cycle (base case $180 per cycle). Implementing paclitaxel instead of bleomycin–vincristine would save approximately 6400 life-years and would increase the overall 5-year Kenyan health-care costs by $3·7 million; increased costs would be primarily related to ongoing HIV care given improved survival. Paclitaxel would substantially increase life expectancy and be cost-effective compared with bleomycin–vincristine for advanced AIDS-associated Kaposi sarcoma in Kenya and should be the standard of care. PLD would further improve survival and be cost-effective with a 44% price reduction. US National Institutes of Health and Massachusetts General Hospital. For the Swahili translation of the abstract see Supplementary Materials section.

中文翻译：

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肯尼亚治疗晚期艾滋病相关卡波西肉瘤的四种化疗方案的评估：成本效益分析

晚期艾滋病相关卡波西肉瘤最有效的治疗方法是紫杉醇或聚乙二醇脂质体阿霉素（PLD）；由于可用性有限且成本高昂，这两种方法在撒哈拉以南非洲地区都没有常规使用。我们研究了紫杉醇或 PLD 与依托泊苷或博来霉素长春新碱在肯尼亚的临床影响、成本和成本效益。在这项研究中，我们使用预防艾滋病并发症的成本效益（CEPAC）国际模型来预测艾滋病毒感染者和晚期卡波西肉瘤患者抗逆转录病毒治疗的临床结果和成本。我们比较了四种不同的治疗策略：依托泊苷、博莱霉素-长春新碱、紫杉醇或 PLD。我们从肯尼亚提供医疗保健网络的学术模型中得出队列特征和成本，并从临床试验中得出不良事件、疗效和死亡率。我们预测了一生的模型结果，包括预期寿命、人均一生成本和增量成本效益比 (ICER)。我们对 5 年总成本进行了预算影响分析，并进行了确定性和概率敏感性分析，以评估输入参数不确定性的影响。我们发现紫杉醇比博来霉素-长春新碱更有效，并且可以将每人的预期寿命延长 4·2 年。PLD 将使人均预期寿命进一步延长 0·6 年。紫杉醇将是最具成本效益的策略（与博莱霉素-长春新碱相比，每年挽救生命的 ICER 为 380 美元），并且在多种情况下仍保持成本效益。如果 PLD 的价格降低至每个周期 100 美元（基本情况为每个周期 180 美元），那么与紫杉醇相比，PLD 将更具成本效益。使用紫杉醇代替博莱霉素-长春新碱将挽救大约 6400 个生命年，并将使肯尼亚 5 年总体医疗保健费用增加 3·700 万美元；成本增加主要与持续的艾滋病毒护理有关，因为生存率有所提高。与博来霉素-长春新碱相比，紫杉醇可显着延长肯尼亚晚期艾滋病相关卡波西肉瘤的预期寿命，并且具有成本效益，因此应成为标准治疗方法。PLD 将进一步提高生存率并具有成本效益，价格可降低 44%。美国国立卫生研究院和马萨诸塞州总医院。有关摘要的斯瓦西里语翻译，请参阅补充材料部分。