Rajasingham Radha, Medina Narda, Mousquer Gabriel T, Caceres Diego H, Jordan Alexander, Nacher Mathieu, Falci Diego R, Sebro Ayanna, Pasqualotto Alessandro C, Sued Omar, Chiller Tom, Perez Freddy
Division of Infectious Diseases & International Medicine, Department of Medicine, University of Minnesota, Minneapolis, Minnesota, United States of America.
ASRT, Inc., Mycotic Diseases Branch, Division of Foodborne, Waterborne, and Environmental Diseases (DFWED), Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America.
PLOS Glob Public Health. 2023 Aug 15;3(8):e0001861. doi: 10.1371/journal.pgph.0001861. eCollection 2023.
Histoplasma antigen can be detected in people with advanced HIV disease (AHD), allowing for early and accurate diagnosis of histoplasmosis. The aim of this analysis was to assess the cost-effectiveness of routine histoplasmosis screening using antigen detection, among people with AHD. We developed a decision analytic model to evaluate Histoplasma antigen screening among people with AHD. The model estimated the costs, effectiveness, and cost-effectiveness of routine screening for Histoplasma antigen compared to the current practice of no routine Histoplasma antigen screening. The model includes stratification by symptoms of histoplasmosis, severity of presentation, and estimates of 30-day mortality. Data sources were taken from the Pan American Health Organization (PAHO) Strategic Fund databases on public purchases of medicines, and published literature on treatment outcomes. Outcome measures are life years saved (LYS), costs (US dollars), and incremental cost-effectiveness ratios (ICERs). Routine Histoplasma antigen screening avoids an estimated 17% of deaths in persons with advanced HIV disease, and is cost-effective compared to no histoplasmosis screening, with an ICER of $26/LYS. In sensitivity analysis assuming treatment for histoplasmosis with liposomal amphotericin, Histoplasma antigen screening remains cost-effective with an ICER of $607/LYS. Histoplasma antigen screening among people with AHD is a cost-effective strategy and could potentially avert 17% of AIDS-related deaths. Prospective evaluation of histoplasmosis screening is warranted to determine effectiveness and treatment outcomes with this strategy.
在晚期HIV疾病（AHD）患者中可检测到组织胞浆菌抗原，这有助于早期准确诊断组织胞浆菌病。本分析的目的是评估在AHD患者中使用抗原检测进行常规组织胞浆菌病筛查的成本效益。我们开发了一个决策分析模型来评估AHD患者中的组织胞浆菌抗原筛查。该模型估计了与当前不进行常规组织胞浆菌抗原筛查的做法相比，常规筛查组织胞浆菌抗原的成本、效果和成本效益。该模型包括根据组织胞浆菌病症状、表现严重程度以及30天死亡率估计进行分层。数据来源取自泛美卫生组织（PAHO）关于药品公共采购的战略基金数据库以及已发表的关于治疗结果的文献。结果指标为挽救的生命年（LYS）、成本（美元）和增量成本效益比（ICER）。常规组织胞浆菌抗原筛查可避免估计17%的晚期HIV疾病患者死亡，与不进行组织胞浆菌病筛查相比具有成本效益，ICER为26美元/LYS。在假设用脂质体两性霉素治疗组织胞浆菌病的敏感性分析中，组织胞浆菌抗原筛查仍具有成本效益，ICER为607美元/LYS。在AHD患者中进行组织胞浆菌抗原筛查是一种具有成本效益的策略，有可能避免17%与艾滋病相关的死亡。有必要对组织胞浆菌病筛查进行前瞻性评估，以确定该策略的有效性和治疗结果。
