A population‐based analysis of attributable hospitalisation costs of invasive fungal diseases in haematological malignancy patients using data linkage of state‐wide registry and costing databases: 2009‐2015

Abstract

Summary Background Invasive fungal diseases (IFD) are associated with significant treatment‐related costs in patients with haematological malignancies (HM). Objectives The objectives of this study were to characterise the gross and attributable hospitalisation costs of a variety of IFD in patients with HM by linking state‐wide hospital administrative and costing datasets. Patients/Methods We linked the Victorian Admitted Episodes Dataset, Victorian Cancer Registry and the Victorian Cost Data Collection from 1 July 2009 to 30 June 2015. IFD cases and uninfected controls were matched 1:1 based on age within ten years, same underlying HM and length of stay prior to IFD diagnosis. The cost difference between surviving cases and controls, indexed to 2019 Australian dollars (AUD) calculated twelve months from IFD diagnosis, was determined using Poisson and negative binomial regression (NBR). Results From 334 matched pairs, the gross hospitalisation cost of cases was AUD$67 277 compared to AUD$51 158 among uninfected controls, associated with an excess median hospitalisation cost of AUD$16 119 (P < .001) attributable to IFD, approximating to USD$11 362 and €10 154 at purchasing power parity. Median attributable costs were highest for patients with invasive aspergillosis (AUD$55 642; P < .001) and mucormycosis (AUD$51 272; P = .043) followed by invasive candidiasis AUD$24 572 (P < .001). No change in median excess attributable costs was observed over the study period (P = .90) Analyses by NBR revealed a 1.36‐fold increase (P < .001) in total hospitalisation costs among cases as compared to controls twelve months from IFD diagnosis. Conclusion Invasive aspergillosis and mucormycosis have high attributable hospitalisation costs but the overall excess IFD cost of AUD$16 119 is modest, potentially reflecting missed or miscoded fungal episodes arguing for better quality surveillance data at hospital level.

Consensus guidelines for antifungal stewardship, surveillance and infection prevention, 2021

“…There are increasing numbers of immunosuppressed patients at risk of invasive fungal disease (IFD), 1,2 resulting in greater use of antifungal agents to prevent and treat IFD. 3 This, in turn, has led to increases in antifungal drug costs, 4,5 rates of adverse drug reactions 6 and drug-drug interactions. 7 These factors, in addition to the high mortality related to IFD [8][9][10][11] and the emergence of antifungal resistance, 12,13 necessitate the development of AFS programmes in hospitals to monitor and support optimal antifungal prescribing practices.…”

Cost-Effectiveness of Posaconazole vs. First-Generation Triazoles for the Prevention of Invasive Fungal Infections Among High-Risk Patients With Hematological Malignancies in China

“…In China, the incidence of proven or probable IFI was estimated at a rate of 2.1% per chemotherapy course, with a death rate of 11.7% according to data from the China Assessment of Antifungal Therapy in Hematological Diseases (CAESAR) study, which prospectively enrolled 4,192 patients undergoing chemotherapy for hematological malignancies at 35 Chinese hospitals ( 1 ). Patients with IFIs have been reported to have significantly increased hospitalization costs, which impose a heavy economic burden on the healthcare system worldwide ( 2 , 3 ).…”

Clinical and pharmacoeconomic evaluation of antifungal prophylaxis with continuous micafungin in patients undergoing allogeneic stem cell transplantation: A six‐year cohort analysis

“…This is mainly represented by a prolonged hospital length of stay (LOS) especially on the intensive care unit (ICU) and the need of expensive new class antifungal agents. Past studies reported additional direct treatment costs of patients with IFDs of up to €33,000 3–6 . Aspergillus and Candida species are the most common pathogens of IFD; however, the rising incidence of rare fungal infections, such as mucormycosis or fusariosis, represents an additional clinical and economical burden in the care for these patients 7,8 …”

“…Past studies reported additional direct treatment costs of patients with IFDs of up to €33,000. [3][4][5][6] Aspergillus and Candida species are the most common pathogens of IFD; however, the rising incidence of rare fungal infections, such as mucormycosis or fusariosis, represents an additional clinical and economical burden in the care for these patients. 7,8 Effective antifungal prophylaxis strategies after aSCT are needed to improve patient outcome and to prevent high additional treatment costs for healthcare systems.…”