Table 3.
Absolute Costs and Effects for Various Levels of CRAG Screening
| 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 |
Abbreviations: CRAG-LFA cryptococcal antigen lateral flow assay, DALY disability adjusted life-year, ICER incremental cost-effectiveness ratio
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
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%