{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,24]],"date-time":"2025-11-24T07:14:40Z","timestamp":1763968480709,"version":"3.41.2"},"reference-count":37,"publisher":"Oxford University Press (OUP)","issue":"2","license":[{"start":{"date-parts":[[2022,1,13]],"date-time":"2022-01-13T00:00:00Z","timestamp":1642032000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"funder":[{"DOI":"10.13039\/100000060","name":"National Institute of Allergy and Infectious diseases","doi-asserted-by":"crossref","award":["K23AI138851"],"award-info":[{"award-number":["K23AI138851"]}],"id":[{"id":"10.13039\/100000060","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/100000002","name":"NIH","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2022,2,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:label\/>\n                  <jats:p>Cryptococcal antigen (CrAg) screening is recommended for patients with advanced HIV to reduce AIDS-related mortality. For asymptomatic CrAg-positive persons, fluconazole pre-emptive therapy is standard, despite a \u223c25% failure rate. Single-dose liposomal amphotericin B (AmBisome) is non-inferior to standard treatment for cryptococcal meningitis. We evaluate the threshold of efficacy necessary for AmBisome\u00a0+\u00a0fluconazole to be cost-effective as pre-emptive therapy for CrAg-positive persons.<\/jats:p>\n                  <jats:p>We created a decision analytic model to evaluate CrAg screening and treatment in HIV-infected persons with CD4\u00a0&amp;lt;\u00a0100 cells\/\u03bcL. Costs were estimated for screening, pre-emptive therapy, and hospitalization for an example low-income country (Uganda) and middle-income country (South Africa). We used a discounted price range of AmBisome\u00ae at ${\\$}$16.25 to ${\\$}$40 per 50\u00a0mg vial for both Uganda and South Africa. We estimated AmBisome efficacy from 75 to 95%. Parameter assumptions were based on prospective CrAg screening studies and clinical trials in Africa. Disability adjusted life years (DALYs) were calculated using the age-specific life expectancy in Uganda, per WHO Global Health Observatory data. We modeled the theoretical efficacy of adjunctive AmBisome to determine cost per DALY averted.<\/jats:p>\n                  <jats:p>In South Africa, at ${\\$}$16.25 per vial cost and a minimum efficacy of 85%, adjunctive AmBisome is cost-saving compared to fluconazole monotherapy. Compared to fluconazole pre-emptive therapy in Uganda, AmBisome\u00a0+\u00a0fluconazole would cost ${\\$}$475, ${\\$}$220, or ${\\$}$136 per DALY averted if meningitis-free survival efficacy was 80, 85, or 90% at ${\\$}$24 per vial cost.<\/jats:p>\n                  <jats:p>Investing in AmBisome may be cost-effective in low-income settings compared to using fluconazole pre-emptive therapy alone, if efficacy is 85% or greater. AmBisome pre-emptive therapy appears more cost-efficient in middle-income settings where hospitalization costs for meningitis, and GDP per capita are higher.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Lay Summary<\/jats:title>\n                  <jats:p>We evaluate the efficacy necessary for AmBisome\u00a0+\u00a0fluconazole to be cost-effective to prevent cryptococcal meningitis. We found that if AmBisome pre-emptive therapy has an efficacy of 85% or greater, it is likely to be cost-effective in low-income settings.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/mmy\/myab078","type":"journal-article","created":{"date-parts":[[2022,1,12]],"date-time":"2022-01-12T04:21:54Z","timestamp":1641961314000},"source":"Crossref","is-referenced-by-count":3,"title":["Cost-effectiveness of single-dose AmBisome pre-emptive treatment for the prevention of cryptococcal meningitis in African low and middle-income countries"],"prefix":"10.1093","volume":"60","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5531-0231","authenticated-orcid":false,"given":"Radha","family":"Rajasingham","sequence":"first","affiliation":[{"name":"Division of Infectious Diseases & International Medicine, University of Minnesota , MN 55455, 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