Evaluation Of A National Cryptococcal Antigen Screening Program For Hiv-Infected Patients In Uganda: A Cost-Effectiveness Modeling Analysis

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Evaluation Of A National Cryptococcal Antigen Screening Program For Hiv-Infected Patients In Uganda A Cost-Effectiveness Modeling Analysis

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PROJECT TOPIC AND MATERIAL ON EVALUATION OF A NATIONAL CRYPTOCOCCAL ANTIGEN SCREENING PROGRAM FOR HIV-INFECTED PATIENTS IN UGANDA: A COST-EFFECTIVENESS MODELING ANALYSIS

The Project File Details

  • Name: Evaluation Of A National Cryptococcal Antigen Screening Program For Hiv-Infected Patients In Uganda: A Cost-Effectiveness Modeling Analysis
  • Type: PDF and MS Word (DOC)
  • Size: [70 KB]
  • Length: [56] Pages

 

 

Background

Cryptococcal meningitis accounts for 15% of AIDS-related mortality. Cryptococcal antigen (CrAg) is detected in blood weeks before onset of meningitis, and CrAg positivity is an independent predictor of meningitis and death. CrAg screening for patients with advanced HIV and preemptive treatment is recommended by the World Health Organization, though implementation remains limited. Our objective was to evaluate costs and mortality reduction (lives saved) from a national CrAg screening program across Uganda.

Methods

We created a decision analytic model to evaluate CrAg screening. CrAg screening was considered for those with a CD4<100 cells/μL per national and international guidelines, and in the context of a national HIV test-and-treat program where CD4 testing was not available. Costs (2016 USD) were estimated for screening, preemptive therapy, hospitalization, and maintenance therapy. Parameter assumptions were based on large prospective CrAg screening studies in Uganda, and clinical trials from sub Saharan Africa. CrAg positive (CrAg+) persons could be: (a) asymptomatic and thus eligible for preemptive treatment with fluconazole; or (b) symptomatic with meningitis with hospitalization.

Results

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