Health Economic Analysis of the AMBITION Protocol for Human Immunodeficiency Virus-Associated Cryptococcal Meningitis in the United States.

Abstract

Current guideline-compliant management of cryptococcal meningitis (CM), comprised of lipid-based amphotericin (3-5 mg/kg/day) and flucytosine (100 mg/kg/day) for a minimum of 14 days, is associated with significant costs to both the hospital and insurance payor. Recently published studies have found comparable patient outcomes with the cheaper and better tolerated AMBITION protocol (single-dose liposomal amphotericin with 2 weeks of fluconazole and flucytosine). This retrospective, economic evaluation analyzed costs associated with the AMBITION protocol versus guideline-compliant care for patients with human immunodeficiency virus (HIV)-associated CM at a large, academic, public US hospital between August 2020 and July 2024. Treatment of 34 patients with the AMBITION protocol compared to 26 control patients net saved the hospital $399 704 ($11 756 per patient), calculated as variable costs saved minus revenue lost. Cost savings were experienced across all insurance types encountered; however, there were no patients with commercial insurance. In order to accurately model patients who develop CM, we obtained data on the nationwide payor mix for patients with advanced HIV, which still showed net hospital savings, though of smaller magnitude due to lost commercial insurance payments. From an insurance payor perspective, modeling demonstrated cost savings across payor mixes. In this economic evaluation study, the AMBITION protocol was associated with both hospital and payor savings. These findings provide further support for adoption of the AMBITION protocol for treatment of CM in the United States.