{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,24]],"date-time":"2026-10-24T04:42:38Z","timestamp":1792816958584,"version":"4.5.0"},"reference-count":33,"publisher":"Oxford University Press (OUP)","issue":"6","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2024,8,3]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>The risk of developing strongyloidiasis hyperinfection syndrome appears to be elevated among individuals who initiate corticosteroid treatment. Presumptive treatment or treatment after screening for populations from Strongyloides stercoralis-endemic areas has been suggested before initiating corticosteroids. However, potential clinical and economic impacts of preventative strategies have not been evaluated.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>Using a decision tree model for a hypothetical cohort of 1000 individuals from S. stercoralis-endemic areas globally initiating corticosteroid treatment, we evaluated the clinical and economic impacts of two interventions, \u2018Screen and Treat\u2019 (i.e. screening and ivermectin treatment after a positive test), and \u2018Presumptively Treat\u2019, compared to current practice (i.e. \u2018No Intervention\u2019). We evaluated the cost-effectiveness (net cost per death averted) of each strategy using broad ranges of pre-intervention prevalence and hospitalization rates for chronic strongyloidiasis patients initiating corticosteroid treatment.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>For the baseline parameter estimates, \u2018Presumptively Treat\u2019 was cost-effective (i.e. clinically superior with cost per death averted less than a threshold of $10.6 million per life) compared to \u2018No Intervention\u2019 ($532\u2009000 per death averted) or \u2018Screen and Treat\u2019 ($39\u2009000 per death averted). The two parameters contributing the most uncertainty to the analysis were the hospitalization rate for individuals with chronic strongyloidiasis who initiate corticosteroids (baseline 0.166%) and prevalence of chronic strongyloidiasis (baseline 17.3%) according to a series of one-way sensitivity analyses. For hospitalization rates \u22650.022%, \u2018Presumptively Treat\u2019 would remain cost-effective. Similarly, \u2018Presumptively Treat\u2019 remained preferred at prevalence rates of \u22654%; \u2018Screen and Treat\u2019 was preferred for prevalence between 2 and 4% and \u2018No Intervention\u2019 was preferred for prevalence &amp;lt;2%.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>The findings support decision-making for interventions for populations from S. stercoralis-endemic areas before initiating corticosteroid treatment. Although some input parameters are highly uncertain and prevalence varies across endemic countries, \u2018Presumptively Treat\u2019 would likely be preferred across a range for many populations, given plausible parameters.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/jtm\/taad054","type":"journal-article","created":{"date-parts":[[2023,4,19]],"date-time":"2023-04-19T13:45:31Z","timestamp":1681911931000},"source":"Crossref","is-referenced-by-count":8,"title":["Cost-effectiveness of treatment strategies for populations from strongyloidiasis high-risk areas globally who will initiate corticosteroid treatment in the USA"],"prefix":"10.1093","volume":"31","author":[{"given":"Heesoo","family":"Joo","sequence":"first","affiliation":[{"name":"U.S. Centers for Disease Control and Prevention Division of Global Migration and Quarantine, , Atlanta, GA 30329, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brian A","family":"Maskery","sequence":"additional","affiliation":[{"name":"U.S. Centers for Disease Control and Prevention Division of Global Migration and Quarantine, , Atlanta, GA 30329, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonathan D","family":"Alpern","sequence":"additional","affiliation":[{"name":"Minneapolis Veterans Affairs Health Care System Infectious Disease Section, , Minneapolis, MN 55417, USA"},{"name":"University of Minnesota Department of Medicine, Infectious Diseases and International Medicine, , Minneapolis, MN 55455, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michelle","family":"Weinberg","sequence":"additional","affiliation":[{"name":"U.S. Centers for Disease Control and Prevention Division of Global Migration and Quarantine, , Atlanta, GA 30329, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"William M","family":"Stauffer","sequence":"additional","affiliation":[{"name":"U.S. Centers for 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