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Table 3 Absolute Costs and Effects for Various Levels of CRAG Screening

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

Implementation of CRAG screening (%)

 

Universal Screening

0%

25%

50%

75%

100%

Number of Patients eligible for CRAG screening(CD4 < 100) enrolling in care per year

61,400 (13,000–105,000)

61,400 (13,000–105,000)

61,400 (13,000–105,000)

61,400 (13,000–105,000)

61,400 (13,000–105,000)

Number of patients receiving CRAG screening

0

15,350 (3250–26,250)

30,700 (6500–52,500)

46,050 (9750–78,750)

61,400 (13,000–105,000)

Total cost per patienta,b

$9.24 (7.31–18.40)

$9.52 (0.87–26.87)

$9.90 (1.28–27.29)

$10.28 (1.54–27.40)

$10.76 (1.85–28.26)

Incremental Cost per patient, compared to No screeninga,b

REFERENCE

$0.37 (−6.44–8.47)

$0.75 (−6.03–8.89)

$1.13 (−5.77–9.09)

$1.52 (−5.46–9.42)

Total Program Cost

$559,968 (95,000–1,900,000)

$584,528 (123,000–1,930,000)

$607,860 (154,000–1,960,000)

$631,192 (178,000–1,990,000)

$651,454 (198,000–2,100,000)

Total Incremental Program Costs compared to No screeninga,b

REFERENCE

$24,560 (12,000–36,000)

$47,892 (30,000–64,000)

$71,224 (54,000–96,000)

$91,486 (76,000–104,000)

DALYs accumulated per patient

8.55 (6.70–10.90)

8.48 (1.59–10.87)

8.42 (6.53–10.84)

8.36 (6.47–10.82)

8.3 (6.41–10.79)

Total DALYs averted compared to No screening

REFERENCE

4298

7982

11,666

15,350

Deaths from CM (proportion of cohort)

2763 (0.045)

2456 (0.04)

2149 (0.035)

1842 (0.03)

1535 (0.025)

CM deaths averted compared to No screening

REFERENCE

307

614

921

1228

  1. Abbreviations: CRAG-LFA cryptococcal antigen lateral flow assay, DALY disability adjusted life-year, ICER incremental cost-effectiveness ratio
  2. aTotal costs represent total health systems costs, inclusive of diagnostic testing and treatment costs related to diagnosed cryptococcal antigenemia and/or cryptococcal meningitis over a 5 year time period, but excludes lifetime ART costs. Future years are discounted by 3% and ART costs are not included in base case analysis. Costs stratified by source: No screening – Diagnostic costs $0.27 per person, $16,500 total, Treatment costs $8.85 per person, $543,000 total. Universal CRAG screening – Diagnostic costs $2.71 per person, $166,000 total, Treatment costs $7.90 per person, $485,000 total
  3. bTotal cost per patient including lifetime ART: $5772 at 0%, $5807 at 25%, $5842 at 50%, $5876 at 75%, $5911 at 100%. Projected total program cost including lifetime ART: $354,400,800 at 0%, $89,133,613 at 25%, $179,318,700 at 50%, $270,601,313 at 75%, $362,935,400 at 100%