Cost-effectiveness of CRAG-LFA screening for cryptococcal meningitis among people living with HIV in Uganda.
Background: Cryptococcal meningitis (CM) constitutes a significant source of mortality in resource-limited regions. Cryptococcal antigen (CRAG) can be detected in the blood before onset of meningitis. We sought to determine the cost-effectiveness of implementing CRAG screening using the recently dev...
| Publicado en: | BMC Infectious Diseases Vol. 17; pp. 1 - 11 |
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| Autores principales: | , , , |
| Formato: | Journal Article |
| Publicado: |
BioMed Central
3/23/2017
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| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=122050263&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 122050263 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 14712334 1CHU jtl: BMC Infectious Diseases issn: 14712334 maglogo: N pubinfo: dt: 3/23/2017 vid: 17 pid: 24147 pub: BioMed Central artinfo: ui: 122050263 122050263 NLM28335769 10.1186/s12879-017-2325-9 NLM28335769 122050263 ppf: 1 ppct: 10 formats: tig: atl: Cost-effectiveness of CRAG-LFA screening for cryptococcal meningitis among people living with HIV in Uganda. aug: au: Ramachandran, Anu Manabe, Yukari Rajasingham, Radha Shah, Maunank affil: Johns Hopkins University School of Medicine, 725 N. Wolfe St. PCTB building-224, Baltimore, MD 21205, USA sug: subj: Health Screening Economics Cryptococcus Immunology AIDS-Related Opportunistic Infections Diagnosis Meningitis, Cryptococcal Diagnosis Cost Benefit Analysis Antigens, Fungal Blood Adult AIDS-Related Opportunistic Infections Blood Decision Support Techniques Meningitis, Cryptococcal Blood Female Decision Trees Meningitis, Cryptococcal Economics Male AIDS-Related Opportunistic Infections Economics Uganda Models, Statistical Meningitis, Cryptococcal Complications Adult: 19-44 years Female Male ab: Background: Cryptococcal meningitis (CM) constitutes a significant source of mortality in resource-limited regions. Cryptococcal antigen (CRAG) can be detected in the blood before onset of meningitis. We sought to determine the cost-effectiveness of implementing CRAG screening using the recently developed CRAG lateral flow assay in Uganda compared to current practice without screening.Methods: A decision-analytic model was constructed to compare two strategies for cryptococcal prevention among people living with HIV with CD4 < 100 in Uganda: No cryptococcal screening vs. CRAG screening with WHO-recommended preemptive treatment for CRAG-positive patients. The model was constructed to reflect primary HIV clinics in Uganda, with a cohort of HIV-infected patients with CD4 < 100 cells/uL. Primary outcomes were expected costs, DALYs, and incremental cost-effectiveness ratios (ICERs). We evaluated varying levels of programmatic implementation in secondary analysis.Results: CRAG screening was considered highly cost-effective and was associated with an ICER of $6.14 per DALY averted compared to no screening (95% uncertainty range: $-20.32 to $36.47). Overall, implementation of CRAG screening was projected to cost $1.52 more per person, and was projected to result in a 40% relative reduction in cryptococcal-associated mortality. In probabilistic sensitivity analysis, CRAG screening was cost-effective in 100% of scenarios and cost saving (ie cheaper and more effective than no screening) in 30% of scenarios. Secondary analysis projected a total cost of $651,454 for 100% implementation of screening nationally, while averting 1228 deaths compared to no screening.Conclusion: CRAG screening for PLWH with low CD4 represents excellent value for money with the potential to prevent cryptococcal morbidity and mortality in Uganda. pubtype: Academic Journal doctype: Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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