ABSTRACT
CASE STUDY: P.J. was a 69-year-old woman who was referred to a large cancer center for an evaluation of brain and lung masses presumed to be cancerous lesions. During the three months before the referral, P.J. had experienced a gradual 40 lb weight loss, shortness of breath with exertion, chest pain, lip tremor, edema and progressive weakening of lower extremities, overall fatigue, and increasing balance and gait disturbances. Her diagnostic workup revealed aspergillosis in her lungs and brain. This case study reports the process of differentiating between cancer and fungal disease, antifungal treatment modalities used, and the multidisciplinary management approach used in the care of P.J.
Subject(s)
Aspergillosis/drug therapy , Brain Diseases/drug therapy , Immunocompetence , Lung Diseases, Fungal/drug therapy , Neuroaspergillosis/drug therapy , Patient Care Team/organization & administration , Aged , Antifungal Agents/adverse effects , Antifungal Agents/therapeutic use , Aspergillosis/complications , Aspergillosis/diagnosis , Brain Diseases/complications , Brain Diseases/diagnosis , Chest Pain/microbiology , Diagnosis, Differential , Drug Interactions , Drug Monitoring , Dyspnea/microbiology , Fatigue/microbiology , Female , Gait Disorders, Neurologic/microbiology , Humans , Lung Diseases, Fungal/complications , Lung Diseases, Fungal/diagnosis , Neuroaspergillosis/complications , Neuroaspergillosis/diagnosis , Paraparesis/microbiology , Patient Selection , Tomography, X-Ray Computed , Weight LossABSTRACT
Patients with malignant brain tumors and deep venous thrombosis (DVT) of the lower extremities are at high risk of developing pulmonary embolism (PE). We developed a Markov model to compare the cost-effectiveness of two strategies to prevent PE in such patients: intra-vena-caval bird's nest filter (BNF) with anticoagulation versus anticoagulation alone. Using the benchmark of 50,000 US dollars per quality-adjusted life year (QALY), BNF was not cost-effective in this population as it reduced the rate of PE at an incremental cost-effectiveness ratio of 198,852 dollars per QALY gained. However, after adjusting the model to reflect the 5-year mortality rate of hypothetical breast cancer patients, BNF was more effective and less expensive than anticoagulation alone. BNF was effective in reducing the rate of PE but was not cost-effective for patients with brain tumors. BNF could be cost-effective for patients with longer life expectancies.
