Evidence map›Paper›PMID 35839816›Full record

ArticleThe Lancet. Global health2022

Evaluation of four chemotherapy regimens for treatment of advanced AIDS-associated Kaposi sarcoma in Kenya: a cost-effectiveness analysis.

Esther E Freeman, Nicole C McCann, Aggrey Semeere, Krishna P Reddy, Miriam Laker-Oketta, Helen Byakwaga, Pamela P Pei, Maya E Hajny Fernandez, Samson Kiprono, Naftali Busakhala and 5 more

Open access · goldAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in The Lancet. Global health, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 5 papers.

0numbers the graph read from it
0cells of the map it votes in
5citing papers in PubMed
0.8field-weighted citation impact, top 26% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

5 citing papers in PubMed, 8 citations in OpenAlex.

  1. Article
  2. Article
  3. Review
  4. AIDS-related Kaposi sarcoma of the oral cavity.Revista da Sociedade Brasileira de Medicina Tropical · 2023
    Article
  5. Malignancy and viral infections in Sub-Saharan Africa: A review.Frontiers in virology (Lausanne, Switzerland) · 2023
    Article
4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

15 authors at 6 institutions in 3 countries.

Esther E FreemanDepartment of Dermatology, Massachusetts General Hospital, Boston, MA, USA; Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Harvard University, Boston, MA, USA. Electronic address: efreeman@mgh.harvard.edu.
Nicole C McCannMedical Practice Evaluation Center, Massachusetts General Hospital, Boston, MA, USA.
Aggrey SemeereInfectious Diseases Institute, Kampala, Uganda; Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA.
Krishna P ReddyMedical Practice Evaluation Center, Massachusetts General Hospital, Boston, MA, USA; Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Harvard University, Boston, MA, USA.
Miriam Laker-OkettaInfectious Diseases Institute, Kampala, Uganda.
Helen ByakwagaInfectious Diseases Institute, Kampala, Uganda.
Pamela P PeiMedical Practice Evaluation Center, Massachusetts General Hospital, Boston, MA, USA.
Maya E Hajny FernandezMedical Practice Evaluation Center, Massachusetts General Hospital, Boston, MA, USA.
Samson KipronoDepartment of Internal Medicine, Moi University School of Medicine, Eldoret, Kenya.
Naftali BusakhalaDepartment of Internal Medicine, Moi University School of Medicine, Eldoret, Kenya; Department of Pharmacology and Toxicology, Moi University School of Medicine, Eldoret, Kenya.
Jeffery N MartinDepartment of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA.
Toby MaurerDepartment of Dermatology, Indiana University School of Medicine, Indianapolis, IN, USA.
Ingrid V BassettMedical Practice Evaluation Center, Massachusetts General Hospital, Boston, MA, USA; Division of Infectious Disease, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Harvard University, Boston, MA, USA.
Kenneth A FreedbergMedical Practice Evaluation Center, Massachusetts General Hospital, Boston, MA, USA; Division of Infectious Disease, Massachusetts General Hospital, Boston, MA, USA; Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Harvard University, Boston, MA, USA.
Emily P HyleMedical Practice Evaluation Center, Massachusetts General Hospital, Boston, MA, USA; Division of Infectious Disease, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Harvard University, Boston, MA, USA.
Massachusetts General Hospital · USHarvard University · USInfectious Diseases Institute · UGMoi University · KEIndiana University – Purdue University Indianapolis · USUniversity of California, San Francisco · US

Funding

Virology CoreP30AI027763 · NIAID · UNIVERSITY OF CALIFORNIA, SAN FRANCISCO · PI STEVEN Grant DEEKS · 1988 to 2026
$93.6M
East Africa International Epidemiology Database to evaluate AIDS (IeDEA) Regional ConsortiumU01AI069911 · NIAID · INDIANA UNIV-PURDUE UNIV AT INDIANAPOLIS · PI AGGREY SEMWENDERO SEMEERE, Kara Kay Wools-Kaloustian · 2006 to 2026
$57.7M
Unfolded Protein Response and Autophagy in T Helper Cell Effector FunctionP20GM121176 · NIGMS · UNIVERSITY OF NEW MEXICO HEALTH SCIS CTR · PI June Bryan de la Pena · 2017 to 2026
$24.9M
Optimizing HIV Care in Less Developed CountriesR01AI058736 · NIAID · MASSACHUSETTS GENERAL HOSPITAL · PI Kenneth Alan Freedberg, Emily Parker Hyle · 2004 to 2026
$21.5M
Novel Methods to Inform HIV/TB Clinical Trial DevelopmentR01AI093269 · NIAID · MASSACHUSETTS GENERAL HOSPITAL · PI REDDY, KRISHNA P · 2011 to 2024
$6.8M
Optimizing HIV Care in Less Developed CountriesR37AI058736 · NIAID · MASSACHUSETTS GENERAL HOSPITAL · PI FREEDBERG, KENNETH ALAN · 2018 to 2024
$6.6M
United States-East Africa HIV-Associated Malignancy Research Center (USEAHAMRC) for Career Development and the Prevention, Early Detection and Efficient Linkage to Care for Virus-related CancersU54CA254571 · NCI · UNIVERSITY OF CALIFORNIA, SAN FRANCISCO · PI KIRAGGA, AGNES NAJJUKO · 2020 to 2025
$5.6M
Why do Patients Develop KSU54CA190153 · NCI · UNIVERSITY OF CALIFORNIA, SAN FRANCISCO · PI KAMBUGU, ANDREW DDUNGU, MARTIN, JEFFREY N · 2014 to 2019
$3.6M
Mentoring in patient-oriented research on HIV prevention in the US and South AfricaK24AI141036 · NIAID · MASSACHUSETTS GENERAL HOSPITAL · PI Ingrid Valerie Bassett · 2019 to 2026
$1.1M
Improving the Care Cascade for HIV-associated Kaposi's Sarcoma in sub-Saharan AfricaK23AI136579 · NIAID · MASSACHUSETTS GENERAL HOSPITAL · PI FREEMAN, ESTHER E · 2018 to 2022
$1.1M
Cardiovascular Disease in South African HIV Patients: Value of PreventionK01HL123349 · NHLBI · MASSACHUSETTS GENERAL HOSPITAL · PI HYLE, EMILY PARKER · 2016 to 2020
$896k
NCI NIH HHS U54 CA190153NCI NIH HHS U54 CA254571NHLBI NIH HHS K01 HL123349NIAID NIH HHS K23 AI136579NIAID NIH HHS K24 AI141036NIAID NIH HHS P30 AI027763NIAID NIH HHS R01 AI058736NIAID NIH HHS R01 AI093269NIAID NIH HHS R37 AI058736NIAID NIH HHS U01 AI069911NIGMS NIH HHS P20 GM121176
6 · The paper itself

Abstract

backgroundThe 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.

methodsIn 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.

findingsWe 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.

interpretationPaclitaxel 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.

fundingUS National Institutes of Health and Massachusetts General Hospital. TRANSLATION: For the Swahili translation of the abstract see Supplementary Materials section.

Indexed as

Acquired Immunodeficiency SyndromeHIV InfectionsSarcoma, KaposiBleomycinCost-Benefit AnalysisEtoposideHumansKenyaPaclitaxelVincristineBleomycinEtoposidePaclitaxelVincristine

Identifiers

PMID35839816
PMCPMC9287596
OpenAlexW4285082488

What OpenQuestion holds

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.