Pneumocystis carinii pneumonia (PCP) is one of the most costly opportunistic infections among persons with AIDS. Over 50 percent of patients develop toxicity to the major anti-PCP medications, trimethoprim-sulfamethoxazole (TMP/SMX) and pentamidine. Atovaquone was recently approved for persons with mild to moderate PCP who are intolerant to TMW/SMX. A decision-tree model was developed to estimate the costs and cost-effectiveness of atoavquone therapy compared to intravenous pentamidine therapy for TMP/SMX intolerant patients with mild to moderate PCP. Clinical outcomes are based on data from a randomized controlled trial comparing the two medications. The economic outcomes are based on treatment algorithms derived from discharge data, published reports, and clinical judgement. The total expected cost of treating a patient with atovaquone is $3,990 compared to $5,665 for pentamidine under the baseline scenario. The decision model provides insights into the large cost-savings associated with treating mild to moderate PCP on an outpatient basis.

Acquired Immunodeficiency Syndrome/COMPLICATIONS Antifungal Agents/*THERAPEUTIC USE Cost of Illness *Cost-Benefit Analysis Human Infusions, Intravenous Naphthoquinones/*THERAPEUTIC USE Pentamidine/ADMINISTRATION & DOSAGE/*THERAPEUTIC USE Pneumonia, Pneumocystis carinii/COMPLICATIONS/*PREVENTION & CONTROL ABSTRACT

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