Abstract

Objectives

To estimate the direct and indirect costs of disseminated histoplasmosis in people living with HIV in Brazil in 2023.

Methods

The cost-of-illness study was conducted from the perspective of the Brazilian public health system and society. A hypothetical cohort was developed based on epidemiological data on HIV and histoplasmosis cases reported by the Brazilian Ministry of Health in 2023. Direct medical costs for diagnostic, treatment, and care provided to patients with disseminated histoplasmosis and HIV were calculated using the top-down approach. The indirect costs related to productivity loss due to premature mortality and morbidity were estimated using the human-capital method. A multivariate deterministic sensitivity analysis was performed because of uncertainties in some model parameters.

Results

The cohort began with reported cases of HIV, focusing on individuals estimated to develop symptoms of disseminated histoplasmosis requiring hospitalization. Cases were confirmed through clinical examinations and conventional laboratory methods. Treatment primarily involves amphotericin B. The analysis included patients who were discharged from the hospital, underwent secondary prophylaxis, potentially required treatment for reinfection or reactivation, necessitating additional hospitalization and who died. In 2023, the total cost of disseminated histoplasmosis in people living with HIV in Brazil was US dollars ($) 455 723 307.45, varying, according to the sensitivity analysis, from $283 862 967.76 to $635 305 985.67. Most costs (46%) were associated with indirect costs.

Conclusions

disseminated histoplasmosis represents a significant and costly health problem for both the Brazilian public health system and society, primarily because of productivity loss resulting from premature mortality.