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 Table of Contents  
LETTER TO EDITOR
Year : 2018  |  Volume : 7  |  Issue : 4  |  Page : 395-396

Cryptococcal antigenemia screening among human immunodeficiency virus-infected cases with tuberculosis: Chance and cost effectiveness


1 KMT Primary Care Center, Bangkok, Thailand
2 Department of Community Medicine, Dr. DY Patil University, Pune, Maharashtra, India

Date of Web Publication5-Dec-2018

Correspondence Address:
Sora Yasri
KMT Primary Care Center, Bangkok
Thailand
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijmy.ijmy_117_18

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How to cite this article:
Yasri S, Wiwanitkit V. Cryptococcal antigenemia screening among human immunodeficiency virus-infected cases with tuberculosis: Chance and cost effectiveness. Int J Mycobacteriol 2018;7:395-6

How to cite this URL:
Yasri S, Wiwanitkit V. Cryptococcal antigenemia screening among human immunodeficiency virus-infected cases with tuberculosis: Chance and cost effectiveness. Int J Mycobacteriol [serial online] 2018 [cited 2018 Dec 11];7:395-6. Available from: http://www.ijmyco.org/text.asp?2018/7/4/395/246911



Dear Editor,

Human immunodeficiency virus (HIV) infection is important virus infection that is the present global public health consideration. With the immunodeficiency, the HIV-infected patients usually get superimposed infection. Tuberculosis, a Mycobacterium infection, is a common problem in HIV-infected patients. Additional to tuberculosis, there are also other opportunistic infections commonly seen in HIV-infected patients. Of those infections, cryptococcosis, an invasive fungal disease, is also observable. Anuradha et al.[1] recently mentioned that cryptococcal antigenemia screening among the HIV-infected patients is useful.[1] In a recent report, among asymptomatic HIV-infected cases, 11% show positive result from cryptococcal antigenemia screening.[2] Here, the authors would like to discuss the cryptococcal antigenemia screening among HIV-infected cases with tuberculosis. In addition, cost-effectiveness analysis on using cryptococcal antigenemia screening among HIV-infected cases with tuberculosis is also done. The referencing setting in this work is Thailand, a Southeast Asian country where the HIV infection is prevalent. To perform a cost-effective analysis, the data on cost, present in USD, from referencing cost of Thai Ministry of Public Health was used and the effectiveness is referred to the detection rate in the previous screening test study in Thailand.[3]

The standard medical economics analysis was done to assess the cost-effectiveness of the screening method. The cost of the test is referred to the standard referenced cost provided by the Thai Ministry of Public Health and hereby presented in USD. The effectiveness of the test is referred to the data from recent report on using cryptococcal antigenemia screening among asymptomatic HIV-infected cases.[2] For comparative purpose, additional analysis is also performed for the use of the screening in the cases that the HIV infected has the clinical problem of lung infection. In that case, the effectiveness of the test is referred to specific report on using cryptococcal antigenemia screening among HIV-infected cases with clinical problem of lung infection.[3] All analyses are based on the situation of Thailand. According to the available data,[3] the screening positive rate from cryptococcal antigenemia screening among HIV-infected cases is equal to 13.1% and the screening positive rate from cryptococcal antigenemia screening among HIV-infected cases with tuberculosis is equal to 19.3%.[3] Based on this data, the calculation showed the increased chance of having positive cryptococcal antigenemia is equal to 1.47 times. Regarding cost-effectiveness analysis, the cost of the screening is equal to 5.4 USD (based on the data on 2018) and the effectiveness of the test is as already mentioned. The cost-effectiveness analysis shows that the cost per diagnosis for cryptococcal antigenemia screening among HIV-infected cases and among HIV-infected cases with tuberculosis is equal to 41.2 and 30.0 USD per diagnosis, respectively. It can confirm that having tuberculosis increases the chance to have positive cryptococcal antigenemia and the use of cryptococcal antigenemia screening for HIV infected is more cost-effectiveness in case that the patient has concomitant tuberculosis.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Anuradha S, Narayana HA, Dewan R, Kaur R, Rajeshwari K. Asymptomatic cryptococcal antigenemia in people living with HIV (PLHIV) with severe immunosuppression: Is routine CrAg screening indicated in India? J Assoc Physicians India 2017;65:14-7.  Back to cited text no. 1
    
2.
Kwan CK, Leelawiwat W, Intalapaporn P, Anekthananon T, Raengsakulrach B, Peters PJ, et al. Utility of cryptococcal antigen screening and evolution of asymptomatic cryptococcal antigenemia among HIV-infected women starting antiretroviral therapy in Thailand. J Int Assoc Provid AIDS Care 2014;13:434-7.  Back to cited text no. 2
    
3.
Harris JR, Lindsley MD, Henchaichon S, Poonwan N, Naorat S, Prapasiri P, et al. High prevalence of cryptococcal infection among HIV-infected patients hospitalized with pneumonia in Thailand. Clin Infect Dis 2012;54:e43-50.  Back to cited text no. 3
    




 

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