NOVEL research from Massachusetts General Hospital (MGH), Boston, USA, with colleagues from Uganda and Kenya, showed that the best accessible chemotherapy treatment for Kaposi’s sarcoma (KS), caused by a virus, is cost-effective and could improve clinical outcomes. Despite the availability of antiretroviral therapy, AIDS-associated KS is still a fatal condition that affects low- and middle-income countries.
Different chemotherapy strategies are used in the treatment of KS; however, they differ in their effectiveness, cost, and toxicity. Although paclitaxel and pegylated liposomal doxorubicin are both the most effective and least toxic therapies, they are not cost-effective. Unfortunately, many patients with KS are treated with less effective therapies due to the high cost, even though clinical guidelines advise better tolerated and effective therapies. In East Africa, bleomycin-vincristine is currently used the condition. The researchers carried out an international cost-effectiveness analysis of different chemotherapy strategies for treating advanced KS in patients with HIV on antiretroviral therapy in Kenya.
The results showed that paclitaxel would enhance the clinical outcomes and would be cost-efficient at its current price compared with bleomycin-vincristine in patients with advanced KS. According to the results, the use of paclitaxel in treating patients with HIV and advanced KS in Kenya would improve the life-expectancy by 4.2 years compared with bleomycin-vincristine. Additionally, it would elevate the collective healthcare expenses by about 3.7 million USD, mainly from HIV-related costs because of the extensive life expectancy in patients.
“By encouraging hospitals, health systems, and others to reach for paclitaxel as first line treatment for HIV-associated KS, we can save lives. The majority of deaths from cancer in the world are in low- and middle-income countries, and it is our duty to advocate for the highest quality of care, which, in this case, is also the most cost-effective,” says first author Esther Freeman, Director of Clinical Innovation and Education for the Center for Global Health at MGH and Associate Professor of Dermatology at Harvard Medical School, Boston, Massachusetts, USA. “We also need to advocate for drug companies to reduce the price of effective chemotherapies in sub-Saharan Africa, similarly to what has been done for antiretroviral therapy pricing in the past, so that more people can have access to life-saving treatment.”