Cost-effectiveness of primary prophylaxis of AIDS associated cryptococcosis in Cambodia.

<h4>Background</h4>Cryptococcal infection is a frequent cause of mortality in Cambodian HIV-infected patients with CD4+ count ≤100 cells/µl. This study assessed the cost-effectiveness of three strategies for cryptococcosis prevention in HIV-infected patients.<h4>Methods</h4>A...

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Autores principales:	Romain Micol, Ayden Tajahmady, Olivier Lortholary, Suna Balkan, Catherine Quillet, Jean-Philippe Dousset, Hak Chanroeun, Yoann Madec, Arnaud Fontanet, Yazdan Yazdanpanah
Formato:	article
Lenguaje:	EN
Publicado:	Public Library of Science (PLoS) 2010
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/679c944f8bca4657bf6337aca8028f4e
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spelling	oai:doaj.org-article:679c944f8bca4657bf6337aca8028f4e2021-12-02T20:11:48ZCost-effectiveness of primary prophylaxis of AIDS associated cryptococcosis in Cambodia.1932-620310.1371/journal.pone.0013856https://doaj.org/article/679c944f8bca4657bf6337aca8028f4e2010-11-01T00:00:00Zhttps://www.ncbi.nlm.nih.gov/pmc/articles/pmid/21085478/?tool=EBIhttps://doaj.org/toc/1932-6203<h4>Background</h4>Cryptococcal infection is a frequent cause of mortality in Cambodian HIV-infected patients with CD4+ count ≤100 cells/µl. This study assessed the cost-effectiveness of three strategies for cryptococcosis prevention in HIV-infected patients.<h4>Methods</h4>A MARKOV DECISION TREE WAS USED TO COMPARE THE FOLLOWING STRATEGIES AT THE TIME OF HIV DIAGNOSIS: no intervention, one time systematic serum cryptococcal antigen (CRAG) screening and treatment of positive patients, and systematic primary prophylaxis with fluconazole. The trajectory of a hypothetical cohort of HIV-infected patients with CD4+ count ≤100 cells/µl initiating care was simulated over a 1-year period (cotrimoxazole initiation at enrollment; antiretroviral therapy within 3 months). Natural history and cost data (US$ 2009) were from Cambodia. Efficacy data were from international literature.<h4>Results</h4>In a population in which 81% of patients had a CD4+ count ≤50 cells/ µl and 19% a CD4+ count between 51-100 cells/µl, the proportion alive 1 year after enrollment was 61% (cost $ 472) with no intervention, 70% (cost $ 483) with screening, and 72% (cost $ 492) with prophylaxis. After one year of follow-up, the cost-effectiveness of screening vs. no intervention was US$ 180/life year gained (LYG). The cost-effectiveness of prophylaxis vs. screening was $ 511/LYG. The cost-effectiveness of prophylaxis vs. screening was estimated at $1538/LYG if the proportion of patients with CD4+ count ≤50 cells/µl decreased by 75%.<h4>Conclusion</h4>In a high endemic area of cryptococcosis and HIV infection, serum CRAG screening and prophylaxis are two cost effective strategies to prevent AIDS associated cryptococcosis in patients with CD4+ count ≤100 cells/µl, at a short-term horizon, screening being more cost-effective but less effective than prophylaxis. Systematic primary prophylaxis may be preferred in patients with CD4+ below 50 cells/µl while systematic serum CRAG screening for early targeted treatment may be preferred in patients with CD4+ between 51-100 cells/µl.Romain MicolAyden TajahmadyOlivier LortholarySuna BalkanCatherine QuilletJean-Philippe DoussetHak ChanroeunYoann MadecArnaud FontanetYazdan YazdanpanahPublic Library of Science (PLoS)articleMedicineRScienceQENPLoS ONE, Vol 5, Iss 11, p e13856 (2010)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Romain Micol Ayden Tajahmady Olivier Lortholary Suna Balkan Catherine Quillet Jean-Philippe Dousset Hak Chanroeun Yoann Madec Arnaud Fontanet Yazdan Yazdanpanah Cost-effectiveness of primary prophylaxis of AIDS associated cryptococcosis in Cambodia.
description	<h4>Background</h4>Cryptococcal infection is a frequent cause of mortality in Cambodian HIV-infected patients with CD4+ count ≤100 cells/µl. This study assessed the cost-effectiveness of three strategies for cryptococcosis prevention in HIV-infected patients.<h4>Methods</h4>A MARKOV DECISION TREE WAS USED TO COMPARE THE FOLLOWING STRATEGIES AT THE TIME OF HIV DIAGNOSIS: no intervention, one time systematic serum cryptococcal antigen (CRAG) screening and treatment of positive patients, and systematic primary prophylaxis with fluconazole. The trajectory of a hypothetical cohort of HIV-infected patients with CD4+ count ≤100 cells/µl initiating care was simulated over a 1-year period (cotrimoxazole initiation at enrollment; antiretroviral therapy within 3 months). Natural history and cost data (US$ 2009) were from Cambodia. Efficacy data were from international literature.<h4>Results</h4>In a population in which 81% of patients had a CD4+ count ≤50 cells/ µl and 19% a CD4+ count between 51-100 cells/µl, the proportion alive 1 year after enrollment was 61% (cost $ 472) with no intervention, 70% (cost $ 483) with screening, and 72% (cost $ 492) with prophylaxis. After one year of follow-up, the cost-effectiveness of screening vs. no intervention was US$ 180/life year gained (LYG). The cost-effectiveness of prophylaxis vs. screening was $ 511/LYG. The cost-effectiveness of prophylaxis vs. screening was estimated at $1538/LYG if the proportion of patients with CD4+ count ≤50 cells/µl decreased by 75%.<h4>Conclusion</h4>In a high endemic area of cryptococcosis and HIV infection, serum CRAG screening and prophylaxis are two cost effective strategies to prevent AIDS associated cryptococcosis in patients with CD4+ count ≤100 cells/µl, at a short-term horizon, screening being more cost-effective but less effective than prophylaxis. Systematic primary prophylaxis may be preferred in patients with CD4+ below 50 cells/µl while systematic serum CRAG screening for early targeted treatment may be preferred in patients with CD4+ between 51-100 cells/µl.
format	article
author	Romain Micol Ayden Tajahmady Olivier Lortholary Suna Balkan Catherine Quillet Jean-Philippe Dousset Hak Chanroeun Yoann Madec Arnaud Fontanet Yazdan Yazdanpanah
author_facet	Romain Micol Ayden Tajahmady Olivier Lortholary Suna Balkan Catherine Quillet Jean-Philippe Dousset Hak Chanroeun Yoann Madec Arnaud Fontanet Yazdan Yazdanpanah
author_sort	Romain Micol
title	Cost-effectiveness of primary prophylaxis of AIDS associated cryptococcosis in Cambodia.
title_short	Cost-effectiveness of primary prophylaxis of AIDS associated cryptococcosis in Cambodia.
title_full	Cost-effectiveness of primary prophylaxis of AIDS associated cryptococcosis in Cambodia.
title_fullStr	Cost-effectiveness of primary prophylaxis of AIDS associated cryptococcosis in Cambodia.
title_full_unstemmed	Cost-effectiveness of primary prophylaxis of AIDS associated cryptococcosis in Cambodia.
title_sort	cost-effectiveness of primary prophylaxis of aids associated cryptococcosis in cambodia.
publisher	Public Library of Science (PLoS)
publishDate	2010
url	https://doaj.org/article/679c944f8bca4657bf6337aca8028f4e
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Cost-effectiveness of primary prophylaxis of AIDS associated cryptococcosis in Cambodia.

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