ArticlePloS one2013
Cost effectiveness of cryptococcal antigen screening as a strategy to prevent HIV-associated cryptococcal meningitis in South Africa.
Article in PloS one, 2013. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 75 papers, 1 of them a synthesis that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
75 citing papers in PubMed, 1 synthesis or guideline pooled it, 129 citations in OpenAlex.
- CD4 Cell Count Threshold for Cryptococcal Antigen Screening of HIV-Infected Individuals: A Systematic Review and Meta-analysis.Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2018Pooled it
- Trial
- Hospitalization Free-Survival, Adverse Drug Reactions, and Retention in Care Outcomes of an Outpatient Treatment Model for Cryptococcal Meningitis in PLWH in Maputo, Mozambique.Tropical medicine and infectious disease · 2026Article
- Reflexed cryptococcal antigenaemia detection rates in the Western Cape, South Africa.Southern African journal of HIV medicine · 2025Article
- Prevalence of Cryptococcal Antigenemia and Lateral Flow Assay Accuracy in Severely Immunosuppressed AIDS Patients.Journal of fungi (Basel, Switzerland) · 2024Article
- Implementation of a rapid diagnostic assay package for cryptococcosis, histoplasmosis and tuberculosis in people living with HIV in Paraguay.BMC infectious diseases · 2024Article
- Cryptococcal meningitis.Nature reviews. Disease primers · 2023Review
- An Overview of Diagnostic and Management Strategies for Talaromycosis, an Underrated Disease.Journal of fungi (Basel, Switzerland) · 2023Review
- A multicenter survey of asymptomatic cryptococcal antigenemia among patients with advanced HIV disease in Nigeria.PLOS global public health · 2023Article
- Prevalence and Associated Factors of Cryptococcal Antigenemia in HIV-Infected Patients with CD4 < 200 Cells/µL in São Paulo, Brazil: A Bayesian AnalysisJournal of fungi (Basel, Switzerland) · 2022Article
- Implementation of tuberculosis and cryptococcal meningitis rapid diagnostic tests amongst patients with advanced HIV at Kamuzu Central Hospital, Malawi, 2016-2017.BMC infectious diseases · 2022Article
- Orthostatic hypotension as the initial presentation of disseminated cryptococcosis in a kidney transplant recipient.IDCases · 2022Article
- Etiology of meningitis among adults in three quaternary hospitals in Mozambique, 2016-2017: The role of HIV.PloS one · 2022Article
- Minimally Invasive Tissue Sampling: A Tool to Guide Efforts to Reduce AIDS-Related Mortality in Resource-Limited Settings.Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2021Article
- Reply to the Author.Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2021Article
- A global call for talaromycosis to be recognised as a neglected tropical disease.The Lancet. Global health · 2021Review
- Survival following screening and preemptive antifungal therapy for subclinical cryptococcal disease in advanced HIV infection.AIDS (London, England) · 2021Article
- High prevalence of Cryptococcal antigenemia using a finger-prick lateral flow assay in individuals with advanced HIV disease in Santarém Municipality, Brazilian Amazon Basin.Medical mycology · 2021Article
- High burden of cryptococcal antigenemia and meningitis among patients presenting at an emergency department in Maputo, Mozambique.PloS one · 2021Article
- Potential missed opportunities for diagnosis of cryptococcosis and the association with mortality: A cohort study.EClinicalMedicine · 2020Article
15 more citing papers are in PubMed but not listed here.
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
6 authors at 4 institutions in 2 countries.
Funding
Abstract
objectivesCryptococcal meningitis (CM)-related mortality may be prevented by screening patients for sub-clinical cryptococcal antigenaemia (CRAG) at antiretroviral-therapy (ART) initiation and pre-emptively treating those testing positive. Prior to programmatic implementation in South Africa we performed a cost-effectiveness analysis of alternative preventive strategies for CM.
designCost-effectiveness analysis.
methodsUsing South African data we modelled the cost-effectiveness of four strategies for patients with CD4 cell-counts <100 cells/µl starting ART 1) no screening or prophylaxis (standard of care), 2) universal primary fluconazole prophylaxis, 3) CRAG screening with fluconazole treatment if antigen-positive, 4) CRAG screening with lumbar puncture if antigen-positive and either amphotericin-B for those with CNS disease or fluconazole for those without. Analysis was limited to the first year of ART.
resultsThe least costly strategy was CRAG screening followed by high-dose fluconazole treatment of all CRAG-positive individuals. This strategy dominated the standard of care at CRAG prevalence ≥0.6%. Although CRAG screening followed by lumbar puncture in all antigen-positive individuals was the most effective strategy clinically, the incremental benefit of LPs and amphotericin therapy for those with CNS disease was small and additional costs were large (US$158 versus US$51 per person year; incremental cost effectiveness ratio(ICER) US$889,267 per life year gained). Both CRAG screening strategies are less costly and more clinically effective than current practice. Primary prophylaxis is more effective than current practice, but relatively cost-ineffective (ICER US$20,495).
conclusionsCRAG screening would be a cost-effective strategy to prevent CM-related mortality among patients initiating ART in South Africa. These findings provide further justification for programmatic implementation of CRAG screening.
Indexed as
Identifiers
What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.