Although antiretroviral therapy has markedly improved survival in individuals with AIDS-associated Kaposi sarcoma (a style of cancer brought on by a virus), the condition remains to be a life-threatening problem in low- and middle-income countries.
Latest research led by researchers at Massachusetts General Hospital (MGH) with Ugandan and Kenyan colleagues published in The Lancet Global Health indicates that the very best available chemotherapy for Kaposi sarcoma, which is infrequently utilized in Africa, would improve clinical outcomes and be cost-effective at its current price compared with therapies which can be most incessantly provided within the region.
For treating Kaposi sarcoma, different chemotherapy regimens vary in effectiveness, toxicity, and price. Paclitaxel and pegylated liposomal doxorubicin (PLD) are probably the most effective and least toxic therapies, but they’re dearer than other options.
Despite clinical guidelines that endorse the simpler and higher tolerated chemotherapy regimens for Kaposi sarcoma, too many individuals with HIV are still treated with less effective chemotherapy due to logistics and price.”
Emily P. Hyle, MD, senior writer, physician-investigator on the Medical Practice Evaluation Center at Mass General and Assistant Professor of Medicine at Harvard Medical School
Hyle and first writer Esther Freeman, MD, PhD, Director of Clinical Innovation & Education for the Center for Global Health at Mass General and Associate Professor of Dermatology at Harvard Medical School, led a world collaboration to perform a cost-effectiveness evaluation of various chemotherapy regimens for treating advanced Kaposi sarcoma in individuals with HIV on antiretroviral therapy in Kenya.
They found that paclitaxel would improve clinical outcomes and be very cost-effective at its current price compared with bleiomycin-vincristine, which is probably the most incessantly used treatment for advanced Kaposi sarcoma in East Africa.
Over five years, using paclitaxel as a substitute of bleomycin-vincristine to treat 19,150 individuals with HIV and advanced Kaposi sarcoma in Kenya would save 6,400 years-of-life and would increase cumulative healthcare expenditures by roughly $3.7 million, mostly from HIV-related costs on account of a chronic life expectancy amongst patients.
At current estimates, PLD would further extend life expectancy but wouldn’t be cost-effective compared with paclitaxel; nevertheless, this could possibly be addressed if its price was reduced. “PLD is even higher tolerated than paclitaxel, and our evaluation showed that it will be cost-effective compared with paclitaxel if a 44% price reduction was achieved,” says Hyle.
At a person level, paclitaxel would improve life expectancy by 4.2 years compared with bleomycin-vincristine, and PLD would improve life expectancy by a further 0.6 years compared with paclitaxel.
“By encouraging hospitals, health systems, and others to succeed in for paclitaxel as first line treatment for HIV-associated Kaposi’s sarcoma, we will save lives. Nearly all of deaths from cancer on the planet are in low and middle income countries, and it’s our duty to advocate for the very best quality of care, which on this case, can also be probably the most cost-effective,” says Freeman. “We also must advocate for drug corporations to scale back the worth of effective chemotherapies in sub-Saharan Africa, similarly to what has been done for antiretroviral therapy pricing prior to now, in order that more people can have access to life-saving treatment.”
Source:
Massachusetts General Hospital
Journal reference:
Freeman, E.E., et al. (2022) Evaluation of 4 chemotherapy regimens for treatment of advanced AIDS-associated Kaposi sarcoma in Kenya: a cost-effectiveness evaluation. The Lancet Global Health. doi.org/10.1016/S2214-109X(22)00242-X.