ArticleClinical infectious diseases : an official publication of the Infectious Diseases Society of America2026
Clinical Impact and Cost-Effectiveness of Improving Access to Cryptococcal Meningitis Diagnostics and Treatment in Malawi.
Article in Clinical infectious diseases : an official publication of the Infectious Diseases Society of America, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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
0 citing papers in PubMed.
No citing paper in PubMed yet.
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
19 authors.
Funding
Abstract
backgroundCryptococcal meningitis (CM) causes 13%-20% of deaths among people with HIV (PWH) globally. We examined the cost-effectiveness of improving access to CM diagnostics and treatment among PWH initiating HIV care with a positive serum cryptococcal antigen (CrAg) test in Malawi.
methodsWe used the CEPAC-I model to simulate (1) Current care (CM treatment if diagnosed with CM; otherwise preemptive fluconazole) and assessed 7 intervention strategies to expand care: (2) lumbar puncture (LP); (3) semi-quantitative serum CrAg (CrAgSQ) alone; or (4) CrAgSQ plus confirmatory LP for asymptomatic people with CrAg+; and (5) 98% access to liposomal amphotericin B/flucytosine/fluconazole (LAmB/5FC/Fluc) for diagnosed CM, as well as improving access to CM treatment with each diagnostic strategy (6, 7, 8). The simulated cohort has mean CD4 27/µL, age 37 years; 16% have symptomatic CM, 28% asymptomatic CM, and 56% asymptomatic cryptococcemia. Model outcomes include 1-year survival, quality-adjusted life years (QALYs), costs, and incremental cost-effectiveness ratios (ICERs) assessed at 2 cost-effectiveness thresholds: US$150/QALY and US$600/QALY.
resultsCurrent care results in 70% 1-year survival, 10.67 QALYs, and costs US$2290/person. 98% access to LAmB/5FC/Fluc increases survival (+2.2%) and QALYs (+0.33 undiscounted QALYs) at lifetime costs of US$2320/person (ICER, US$140/QALY). CrAgSQ plus confirmatory LP for asymptomatic CrAg+ and 98% access to LAmB/5FC/Fluc results in +6.0% 1-year survival, +0.97 QALYs, +US$190/person (ICER, US$380/QALY). Results are sensitive to test characteristics and uptake.
interpretationImproving access to LAmB/5FC/Fluc and expanding diagnostics to improve detection of asymptomatic CM would improve clinical outcomes and be cost-effective in Malawi and similar settings.
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.