Cost analysis of bronchoalveolar lavage and respiratory tract biopsies in the diagnosis and management of suspected invasive fungal infection in children with cancer or who have undergone stem cell transplant

Abstract

Background Identification of an organism is the gold standard for the diagnosis of fungal infection; however, we have previously shown that invasive procedures infrequently lead to a change in management in children with cancer or who have undergone stem cell transplant with suspected respiratory tract invasive fungal infection (RT‐IFI). There is also a paucity of data on the cost of RT‐IFI in this population. We therefore compared the costs of RT‐IFI diagnosed based on CT scan alone versus those who underwent a bronchoalveolar lavage (BAL) or respiratory tract biopsy (RTB). Procedure We collected cost data on patients at a single center undergoing chemotherapy or who were post‐hematopoietic stem cell transplant (HSCT) and were suspected of having RT‐IFI between 2007 and 2012. Cost data were included for 14 days from the day of their diagnostic CT scan or procedure. Results Cost data were available for 76 patients. Thirty‐six patients were diagnosed with suspected RT‐IFI based on CT only, and 40 patients underwent BAL or RTB. Costs related to chest X‐rays (CXRs), inpatient/intensive care unit (ICU) beds, anesthesia, operating room (OR) time, and procedures were significantly higher in the BAL/RTB group versus CT scan group (all P < 0.01). Costs related to CT scans were significantly higher in the CT scan group (P = 0.0002). Overall costs were significantly higher for patients who underwent BAL or RTB versus CT scan only (P < 0.0001). Conclusion Our previous data showed that BAL and RTB infrequently led to a change in management in this population. We now demonstrate that this strategy is costly as well.

Metagenomic Next-Generation Sequencing Successfully Detects Pulmonary Infectious Pathogens in Children With Hematologic Malignancy

“…It indicated that when routine microbiological tests are adverse and empirical treatment is ineffective, BALF mNGS is undoubtedly a valuable pathogen detection tool. Although the utility of bronchoscopy for children remains to be questioned ( Rossoff et al., 2019 ), this procedure positively impacts the pathogenic diagnosis and a subsequent management adjustment of pulmonary infections in this population ( Wohlfarth et al., 2018 ; Bauer et al., 2019 ). Bronchoalveolar lavage (BAL) is usually more feasible and safer than biopsy ( Rao et al., 2013 ; Chellapandian et al., 2015 ; Elbahlawan et al., 2016 ).…”

Budget Impact of Microbial Cell-Free DNA Testing Using the Karius® Test as an Alternative to Invasive Procedures in Immunocompromised Patients with Suspected Invasive Fungal Infections

“…After the initial decision regarding the use of empiric therapy, the diagnostic tests are ordered. The diagnostic tests incorporated into the model are based on the published estimates by Barnes et al and Rossoff et al as shown in Table 2 [ 4 , 34 ]. The same diagnostic tests were used for both the SoC arm and the Karius Test arm, with the exception of a reduction in bronchoscopy and bronchoalveolar lavage.…”

“… Source: Barnes et al and Rossoff et al [ 4 , 34 ] CT computed tomography, PCR polymerase chain reaction, PET positron emission tomography, SoC standard of care …”

“…Resource use (Table 2 ) and adverse events (Tables 3 and 4 ), which are associated with a cost, have been identified from the literature and are considered in the model [ 4 , 34 ]. The cost year in the analysis was 2018–19 and costs were inflated where necessary.…”

“…Usage of the Karius Test for the detection and identification of invasive fungal infections has been considered as a potential alternative to invasive procedures allowing for rapid results [ 4 , 5 ]. Invasive procedures may be associated with added costs and adverse events.…”