Subject(s)
Meningitis, Fungal/economics , Meningitis, Fungal/microbiology , Candida albicans/genetics , Candida albicans/isolation & purification , Candida albicans/physiology , Candidiasis/diagnosis , Candidiasis/economics , Candidiasis/microbiology , Candidiasis/mortality , Cost of Illness , Cryptococcosis/diagnosis , Cryptococcosis/economics , Cryptococcosis/microbiology , Cryptococcosis/mortality , Cryptococcus neoformans/genetics , Cryptococcus neoformans/isolation & purification , Cryptococcus neoformans/physiology , Humans , Meningitis, Fungal/diagnosis , Meningitis, Fungal/mortalityABSTRACT
PURPOSE: Previous epidemiological and cost studies of fungal meningitis have largely focused on single pathogens, leading to a poor understanding of the disease in general. We studied the largest and most diverse group of fungal meningitis patients to date, over the longest follow-up period, to examine the broad impact on resource utilization within the United States. METHODOLOGY: The Truven Health Analytics MarketScan database was used to identify patients with a fungal meningitis diagnosis in the United States between 2000 and 2012. Patients with a primary diagnosis of cryptococcal, Coccidioides, Histoplasma, or Candida meningitis were included in the analysis. Data concerning healthcare resource utilization, prevalence and length of stay were collected for up to 5 years following the original diagnosis. RESULTS: Cryptococcal meningitis was the most prevalent type of fungal meningitis (70.1â% of cases over the duration of the study), followed by coccidioidomycosis (16.4â%), histoplasmosis (6.0â%) and candidiasis (7.6â%). Cryptococcal meningitis and candidiasis patients accrued the largest average charges ($103â236 and $103â803, respectively) and spent the most time in the hospital on average (70.6 and 79 days). Coccidioidomycosis and histoplasmosis patients also accrued substantial charges and time in the hospital ($82â439, 48.1 days; $78â609, 49.8 days, respectively). CONCLUSION: Our study characterizes the largest longitudinal cohort of fungal meningitis in the United States. Importantly, the health economic impact and long-term morbidity from these infections are quantified and reviewed. The healthcare resource utilization of fungal meningitis patients in the United States is substantial.
Subject(s)
Cost of Illness , Health Resources/statistics & numerical data , Meningitis, Fungal/epidemiology , Meningitis, Fungal/microbiology , Adolescent , Adult , Aged , Aged, 80 and over , Candidiasis/economics , Candidiasis/epidemiology , Candidiasis/microbiology , Coccidioidomycosis/economics , Coccidioidomycosis/epidemiology , Coccidioidomycosis/microbiology , Female , Histoplasmosis/economics , Histoplasmosis/epidemiology , Histoplasmosis/microbiology , Humans , Male , Meningitis, Cryptococcal/economics , Meningitis, Cryptococcal/epidemiology , Meningitis, Cryptococcal/microbiology , Meningitis, Fungal/diagnosis , Meningitis, Fungal/economics , Middle Aged , Prevalence , United States/epidemiology , Young AdultABSTRACT
OBJECTIVE: We evaluated the effectiveness and cost of a fungal meningitis outbreak response in the New River Valley of Virginia during 2012-2013 from the perspective of the local public health department and clinical facilities. The fungal meningitis outbreak affected 23 states in the United States with 751 cases and 64 deaths in 20 states; there were 56 cases and 5 deaths in Virginia. METHODS: We conducted a partial economic evaluation of the fungal meningitis outbreak response in New River Valley. We collected costs associated with the local health department and clinical facilities in the outbreak response and estimated the epidemiological effectiveness by using disability-adjusted life years (DALYs) averted. RESULTS: We estimated the epidemiological effectiveness of this outbreak response to be 153 DALYs averted among the patients, and the costs incurred by the local health department and clinical facilities to be $30,413 and $39,580, respectively. CONCLUSIONS: We estimated the incremental cost-effectiveness ratio of $198 per DALY averted and $258 per DALY averted from the local health department and clinical perspectives, respectively, thereby assisting in impact evaluation of the outbreak response by the local health department and clinical facilities. (Disaster Med Public Health Preparedness. 2018;12:38-46).
