IntroductionThe incidence of Kaposi sarcoma (KS) has increased dramatically among women in sub-Saharan Africa since the onset of the HIV pandemic, but data on KS disease in women are limited. To identify gender-related differences in KS presentation and outcomes, we evaluated the clinical manifestations and response in men and women with AIDS-associated KS in Uganda.Methods and FindingsHIV-infected adults with KS attending the Infectious Diseases Institute (IDI) and Uganda Cancer Institute (UCI) in Kampala, Uganda between 2004 and 2006 were included in a retrospective cohort. Evaluation of KS presentation was based on the clinical features described at the initial KS visit. Response was evaluated as the time to “improvement”, as defined by any decrease in lesion size, lesion number, or edema. The cohort consisted of 197 adults with HIV and KS: 55% (108/197) were women. At presentation, the median CD4 T-cell count was significantly lower in women (58 cells/mm3; IQR 11–156 cells/mm3) than men (124 cells/mm3; IQR 22–254 cells/mm3) (p = 0.02). Women were more likely than men to present with lesions of the face (OR 2.8, 95% CI, 1.4, 5.7; p = 0.005) and hard palate (OR 2.0, 95% CI, 1.1, 3.7; p = 0.02), and were less likely than men to have lower extremity lesions (OR 0.54, 95% CI, 0.3, 0.99; p = 0.05). Women were less likely than men to demonstrate clinical improvement (HR = 0.52, CI 0.31, 0.88; p = 0.01) in multivariate analysis.ConclusionsThe clinical presentation and response of KS differs between men and women in Uganda. These data suggest that gender affects the pathophysiology of KS, which may have implications for the prevention, diagnosis, and treatment of KS in both men and women. Prospective studies are needed to identify predictors of response and evaluate efficacy of treatment in women with KS, particularly in Africa where the disease burden is greatest.

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tions. Seven state Markov model (chronic HCV, sustained virological response, compensated cirrhosis, hepatocellulare carcinoma, liver transplantation and death) was used to estimate clinical effects and costs in lifetime horizon, from Polish public payer perspective. Direct medical costs were considered. Separate analysis was done for genotypes 1,4 (48-week treatment) and genotypes 2,3 (24week treatment). Clinical practice and cost data were gathered from clinical experts or based on the National Health Fund and Ministry of Health published price lists. Sensitivity analysis was conducted in order to assess the robustness of the results. RESULTS: Genotypes 1 and 4: total costs were 92 036 PLN (1 Euroϭ3.96 PLN) for PegIFN␣2a and 87 793 PLN for PegIFN␣2b. Average survival of HCV patient treated with PegIFN␣2a was 27.9 life years (LY) and 14.83 quality adjusted life years (QALY) and treated with PegIFN␣2b was 27.63 LYs and 14.61 QALYs. The incremental cost-effectiveness ratio was 15 878 PLN/LYG and incremental cost-utility ratio was 19 763 PLN/QALY. Values of both ratios fall below the cost-effectiveness threshold assumed in Poland (100 000 PLN/LYG or QALY). Genotypes 2 and 3: Total costs were 32 849 PLN for PegIFN␣2a and 38 071 PLN for PegIFN␣2b. Average survival of HCV patient treated with PegIFN␣2a was 30.79 LYs and 17.15 QALYs and treated with PegIFN␣2b was 30.20 LYs and 16.68 QALYs. The PegIFN␣2a dominated PegIFN␣2b. The results were confirmed in sensitivity analysis. CONCLUSIONS: PegIFN␣2a is a clinically effective and safe treatment for HCV patients and is highly cost-effective (or dominant) from Polish public payer perspective.

OBJECTIVES: This study assesses the cost-effectiveness of universal vaccination with RV5 in a hypothetical cohort of 1,091,156 children in Japan during their first 5 years of life. METHODS: A Markov model was developed to evaluate the cost per quality-adjusted-life-year (QALY) from the healthcare and societal perspectives. The base case scenario assumes 94% of the vaccinated cohort received 3 doses of RV5 orally at 2, 4, and 6 months of age with the remaining children receiving only 1 or 2 doses. In the absence of a vaccination strategy, there is annually 1 death, 78,000 hospitalizations, and 739,874 outpatient visits. The efficacy of RV5 was based on the results of the Rotavirus Efficacy and Safety Trial (REST). The three dose efficacy in REST was similar to the one obtained from clinical trials conducted in Japan. RESULTS: Universal vaccination could reduce hospitalizations by 89% and all symptomatic episodes of rotavirus gastroenteritis by 59%. For the base case scenario, at a cost of JPY 5316 per dose and administration fee of JPY ,100 per dose, the cost per case avoided was JPY 22,704 and the cost per QALY saved was JPY 2,230,978 from the healthcare payer perspective. From the societal perspective, the cost per case avoided was JPY 8,934 and the cost per QALY saved was JPY 877,855. CONCLUSIONS: Using three times the GDP per capita as a threshold, universal vaccination with RV5 is likely to be cost-effective and to result in substantial reductions in rotavirus-related healthcare use in Japan.