Cost-effectiveness of CRAG-LFA screening for cryptococcal meningitis among people living with HIV in Uganda

BMC Infectious Diseases

Research Article

Radha Rajasingham¹  Maunank Shah²  Anu Ramachandran²  Yukari Manabe³ 

[1] Division of Infectious Diseases and International Medicine, Department of Medicine, University of Minnesota, Minneapolis, MN, USA;Johns Hopkins University School of Medicine, 725 N. Wolfe St. PCTB building-224, 21205, Baltimore, MD, USA;Johns Hopkins University School of Medicine, 725 N. Wolfe St. PCTB building-224, 21205, Baltimore, MD, USA;Infectious Diseases Institute, Makerere University College of Health Sciences, Kampala, Uganda;

关键词: Fluconazole;    Lumbar Puncture;    Probabilistic Sensitivity Analysis;    Cryptococcal Meningitis;    Base Case Analysis;   

DOI  :  10.1186/s12879-017-2325-9

 received in 2016-07-11, accepted in 2017-03-15,  发布年份 2017

来源: Springer

【 摘 要 】

BackgroundCryptococcal 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.MethodsA 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.ResultsCRAG 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.ConclusionCRAG screening for PLWH with low CD4 represents excellent value for money with the potential to prevent cryptococcal morbidity and mortality in Uganda.

【 授权许可】

CC BY   
© The Author(s). 2017