Hospital costs, length of stay and mortality attributable to invasive scedosporiosis in haematology patients

Heng, Siow Chin; Slavin, Monica A; Chen, Sharon C.‐A.; Heath, Christopher H.; Nguyen, Quoc; Billah, Baki; Nation, Roger L.; Kong, David Chee Ming

doi:10.1093/jac/dks210

Cited by 14 publications

(10 citation statements)

References 26 publications

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“…Scedosporium species are unique as causative agents of the neardrowning syndrome (7,8), a cerebral infection which is life threatening due to a lack of therapeutic options. The impacts of invasive scedosporiosis on costs of patient care and mortality in Australia were found to be significant (9). Scedosporium species and relatives, particularly Lomentospora prolificans (Scedosporium prolificans), are among the fungi with the highest degrees of resistance to a wide collection of antifungal compounds (10).…”

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confidence: 99%

Susceptibility and Diversity in the Therapy-Refractory Genus Scedosporium

Lackner

Hagen

Meis

et al. 2014

Antimicrob Agents Chemother

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Scedosporium species show decreased susceptibility to the majority of systemic antifungal drugs. Acquired resistance is likely to disseminate differentially with the mode of exchange of genetic material between lineages. Inter-and intraspecific diversities of Scedosporium species were analyzed for three partitions (rDNA internal transcribed spacer gene [ITS], partial ␤-tubulin gene, and amplified fragment length polymorphism profiles), with the aim to establish distribution of resistance between species, populations, and strains. Heterogeneity of and recombination between lineages were determined, and distances between clusters were calculated using a centroid approach. Clinical, geographic, and antifungal data were plotted on diversity networks. Scedosporium minutisporum, Scedosporium desertorum, and Scedosporium aurantiacum were distinguished unambiguously in all partitions and had differential antifungal susceptibility profiles (ASP). Pseudallescheria fusoidea and Pseudallescheria ellipsoidea were indistinguishable from Scedosporium boydii. Pseudallescheria angusta took an intermediate position between Scedosporium apiospermum and S. boydii. Scedosporium boydii and S. apiospermum had identical ASP. Differences in (multi)resistance were linked to individual strains. S. apiospermum and S. boydii showed limited interbreeding and were recognized as valid, sympatric species. The S. apiospermum/S. boydii group, comprising the main clinically relevant Scedosporium species, consists of separate lineages and is interpreted as a complex undergoing sympatric evolution with incomplete lineage sorting. In routine diagnostics, the lineages in S. apiospermum/S. boydii are indicated with the umbrella descriptor "S. apiospermum complex"; individual species can be identified with rDNA ITS with 96.3% confidence. Voriconazole is recommended as the first-line treatment; resistance against this compound is rare.

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confidence: 99%

Susceptibility and Diversity in the Therapy-Refractory Genus Scedosporium

Lackner

Hagen

Meis

et al. 2014

Antimicrob Agents Chemother

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“…A relatively small matched‐pair cohort (334 pairs) reflects the constraints of a cohort‐matched analysis. This study is biased towards a lower acuity IFD population as we included patients who were alive 12 months post‐IFD onset, likely contributing to survivor bias and the lower attributable IFD cost (AUD$16 119) relative to previously published works . Total hospitalisation data collected from the VCDC were an aggregate sum of direct and overhead costs, concealing the distribution of specific cost parameters like diagnostics and drug acquisition costs.…”

Section: Discussionmentioning

confidence: 99%

“…Inpatient hospitalisation costs of IFD in the United States exceed USD$4.5 billion, of which Candida and Aspergillus infections account for the majority at USD$1.4 billion and USD$1.2 billion, respectively . In the Australian healthcare setting, the attributable hospitalisation costs of these infections are predominantly limited to institutional or disease‐specific reports . A conservative estimate of hospitalisation costs attributable to IFD using median quantile regression from a quaternary Australian transplant centre between 2002 and 2007, indexed to 2009, was AUD$30 957 (indexed to AUD$32 111 in 2019), driven primarily by pharmacy costs (64%), of which antifungal drugs comprised 27% .…”

Section: Introductionmentioning

confidence: 99%

“…Mucormycosis is difficult to manage and costly to treat with a median total hospitalisation cost of USD$57 324 (2014) in HM and allogeneic‐haematopoietic stem cell transplantation (allo‐HSCT) patients with similar estimates reported in Germany (€53 261, 2016) . In contrast, there are few data on the economic burden of non‐ Aspergillus moulds, including mucormycosis and scedosporiosis in Australia partly due to their rarity and lack of surveillance systems in hospitals where IFD are managed …”

Section: Introductionmentioning

confidence: 99%

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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

Valentine

Morrissey

Tacey

et al. 2019

Mycoses

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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.

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“…infections is 49.3% and it can rise to 86.7% in patients after hematopoietic cell transplantation. For patients with candidiasis the mortality rate is about 14–36%, for invasive fusariosis it is much higher, and varies from 66 to 75%, and for scedosporiosis the estimated mortality rate is between 65 and 100% [9–11]. Every patient with neutropenia and long lasting pyrexia who is not getting better after antibiotic therapy should be suspected of fungal infection, and there is an urgent need to perform laboratory tests.…”

Section: Introductionmentioning

confidence: 99%

Comparison of clinical pharmacology of voriconazole and posaconazole

Sienkiewicz¹,

Łapiński²,

Wiela−Hojeńska³

2016

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Despite greater knowledge and possibilities in pharmacotherapy, fungal infections remain a challenge for clinicians. As the population of immunocompromised patients and those treated for their hematologic ailments increases, the number of fungal infections grows too. This is why there is still a quest for new antifungal drugs as well as for optimization of pharmacotherapy with already registered pharmaceutics.Voriconazole and posaconazole are broad-spectrum, new generation, triazole antifungal agents. The drugs are used in the pharmacotherapy of invasive aspergillosis, Candida and Fusarium infections. Voriconazole is also used in infections caused by Scedosporium. Posaconazole is used in the treatment of coccidioidomycosis and chromoblastomycosis. Besides some similarities, the two mentioned drugs also show differences in therapeutic indications, pharmacokinetics (mainly absorption and metabolism), frequency and severity of adverse drug reactions, drug–drug interactions and dosage. As both of the drugs are used in the treatment of invasive fungal infections in adults and children, detailed knowledge of the clinical pharmacology of antifungal agents is the main factor in pharmacotherapy optimization in treatment of fungal infections.The goal of the article is to present and compare the clinical pharmacology of voriconazole and posaconazole as well as to point out the indications and contraindications of using the drugs, determine factors influencing their pharmacotherapy, and provide information that might be helpful in the treatment of fungal infections.

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Hospital costs, length of stay and mortality attributable to invasive scedosporiosis in haematology patients

Abstract: SCEDO has substantial impact on hospital resource consumption, LOS and mortality in haematology patients. Risk factors and preventative measures for SCEDO should be further studied.

Cited by 14 publications

References 26 publications

Susceptibility and Diversity in the Therapy-Refractory Genus Scedosporium

Susceptibility and Diversity in the Therapy-Refractory Genus Scedosporium

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

Comparison of clinical pharmacology of voriconazole and posaconazole

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