November 2025
BACKGROUND
This paper presents the rationale and plan for a cost-effectiveness analysis conducted alongside an open-label, prospective, randomized, two-arm, multicenter, non-inferiority study by the Consortium for Advancing the Prevention and Management of Cancer in People with HIV (AMC) in sub-Saharan Africa. The study compares two commonly used chemotherapy agents, paclitaxel (PTX) and pegylated liposomal doxorubicin (PLD), administered intravenously with concomitant antiretroviral therapy (ART) for the treatment of adult persons living with Human Immunodeficiency Virus (HIV) (PLWH) with severe Kaposi sarcoma (KS) according to WHO guidelines. The two regimens are commonly used in high-resource settings but have not been formally compared in lower-resource settings.
METHODS
This study uses a decision-tree model to evaluate the cost-effectiveness of PTX versus PLD for treating severe KS in adults living with HIV. A health system perspective and a two-year time horizon will be applied. Costs, including medications, labs, and hospitalizations, will be estimated using micro-costing and time-and-motion analyses. Health outcomes will be measured in Quality Adjusted Life years using PROMIS 29 + 2 utility scores. Sensitivity analyses will include Daily adjusted life years and Years of Life Lost.
DISCUSSION
This research will provide valuable insights into the cost-effectiveness of these treatments in managing KS. The results of this analysis will have important implications for healthcare providers and policymakers, offering guidance on the optimal treatment approach for HIV-infected individuals with KS.