Background
HIV-associated cryptococcal meningitis is the second leading cause of AIDS-related mortality. Cryptococcal meningitis is a poverty-related disease and the majority of cases occur in settings where resources are limited and access to quality care is often linked to an individual’s ability to pay for services. We have previously demonstrated the efficacy, safety, and cost-effectiveness of a single, high-dose liposomal amphotericin-based treatment regimen within the AMBITION-cm trial. Here we present a five-country, within-trial analysis exploring the individual economic impact of cryptococcal meningitis.
Methods
810 participants were recruited into this sub-study in Botswana, Malawi, South Africa, Uganda and Zimbabwe. We collected data on annual household expenditure, direct costs and indirect costs incurred prior to enrolment and during the ten-week trial period. Costs were inflated and converted to 2022 USD. We calculated out-of-pocket expenditure, lost income, and catastrophic healthcare expenditure. We defined catastrophic healthcare expenditure as costs exceeding 20% of annual household expenditure.
Results
The average total out-of-pocket expenditure plus lost income prior to enrolment was $132. By the point of enrolment 18% (145/810) of participants had already experienced catastrophic healthcare expenditure. Among the 592 participants who survived to ten-weeks, combining out-of-pocket expenditure and lost income, the average individual cost was $516, ranging from $230 in South Africa to $592 in Zimbabwe. More than half (51%, 296/581) experienced catastrophic healthcare expenditure by the end of the trial, ranging from 16% (13/81) in South Africa to 68% (156/229) in Uganda.
Conclusions
This is the first study exploring the individual economic impact experienced by individuals diagnosed with cryptococcal meningitis. The personal economic impact of cryptococcal meningitis is high and more than half of individuals who survive experience catastrophic healthcare expenditure. It is likely these figures are higher outside of the research setting. This highlights the profound financial impact of this devastating infection and provides a rationale to offer financial and social protection to those affected.