Evidence map›Paper›PMID 28335769›Full record

ArticleBMC infectious diseases2017

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

Anu Ramachandran, Yukari Manabe, Radha Rajasingham, Maunank Shah

Open access · goldAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in BMC infectious diseases, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 20 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
20citing papers in PubMed, 1 pooled it
2.4field-weighted citation impact, top 11% of its field
1 · What the graph read from 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.

2 · The registry

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.

3 · Its place in the literature

Who cites it

20 citing papers in PubMed, 1 synthesis or guideline pooled it, 33 citations in OpenAlex.

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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

4 authors at 3 institutions in 2 countries.

Anu RamachandranJohns Hopkins University School of Medicine, 725 N. Wolfe St. PCTB building-224, Baltimore, MD, 21205, USA.
Yukari ManabeJohns Hopkins University School of Medicine, 725 N. Wolfe St. PCTB building-224, Baltimore, MD, 21205, USA.
Radha RajasinghamDivision of Infectious Diseases and International Medicine, Department of Medicine, University of Minnesota, Minneapolis, MN, USA.
Maunank ShahJohns Hopkins University School of Medicine, 725 N. Wolfe St. PCTB building-224, Baltimore, MD, 21205, USA. mshah28@jhmi.edu.
Johns Hopkins University · USInfectious Diseases Institute · UGUniversity of Minnesota · US

Funding

University of Minnesota Clinical and Translational Science Institute (UMN CTSI)UL1TR000114 · NCATS · UNIVERSITY OF MINNESOTA · PI BLAZAR, BRUCE R · 2012 to 2015
$35.0M
Trial for the Optimal Timing of HIV Therapy after Cryptococcal MeningitisU01AI089244 · NIAID · UNIVERSITY OF MINNESOTA · PI BOULWARE, DAVID R · 2010 to 2014
$7.6M
HIV Co-infections in Uganda: TB, Cryptococcus, and Viral Hepatitis.D43TW009771 · FIC · JOHNS HOPKINS UNIVERSITY · PI CASTELNUOVO, BARBARA, KAMBUGU, ANDREW DDUNGU · 2014 to 2023
$3.3M
Implementation Science Approaches for Novel TB Diagnostics in HIV Prevalent AreasK23AI089259 · NIAID · JOHNS HOPKINS UNIVERSITY · PI SHAH, MAUNANK · 2011 to 2015
$681k
FIC NIH HHS D43 TW009771NCATS NIH HHS UL1 TR000114NIAID NIH HHS K23 AI089259NIAID NIH HHS U01 AI089244
6 · The paper itself

Abstract

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.

Indexed as

Cost-Benefit AnalysisAdultAIDS-Related Opportunistic InfectionsAntigens, FungalBiomarkersCryptococcus neoformansDecision Support TechniquesDecision TreesFemaleHumansMaleMass ScreeningMeningitis, CryptococcalModels, EconomicUgandaAntigens, FungalBiomarkers

Identifiers

PMID28335769
PMCPMC5364591
OpenAlexW2600586688

What OpenQuestion holds

Textmetadata
LicenceCC BY
Read underepoch 390

Registered trials

None linked

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.