title: Economic burden of mucormycosis in the United States: can a vaccine be cost-effective?
abstract: Mucormycosis is a life-threatening infection which causes unacceptably high morbidity and mortality despite treatment. Therefore, a vaccine to prevent mucormycosis is desirable. A major barrier to developing an anti-mucormycosis vaccine is the perception that such a vaccine would not be cost-effective to deploy because the disease is rare. We used data from a recent retrospective study to calculate the annual cost to the US healthcare system caused by mucormycosis infections. We created a model to estimate the cost-efficacy of a niche, anti-mucormycosis vaccine deployed in a targeted manner to high-risk patients. We found that each case of mucormycosis results in an average direct cost to the US healthcare system of $97,743, for an overall cost of mucormycosis of $50 million per year. In the base case scenario, targeted deployment of an anti-mucormycosis vaccine would result in a net cost per quality adjusted life year saved (QUALY) of $17,249. Variations in the price of the vaccine, its market penetration, or the cost of infection could dramatically decrease the net cost, and could even result in net savings per QUALY. In conclusion, mucormycosis causes considerable cost to the US health care system. Targeted deployment of a niche vaccine could decrease infection rates and mortality from mucormycosis in a cost-effective manner.
authors.affiliation: Division of Infectious Diseases, Harbor-University of California at Los Angeles Medical Center, and the Los Angeles Biomedical Research Institute, Torrance, California 90502, USA. ibrahim@labiomed.org
authors.forename: Ashraf S
authors.initials: AS
authors.lastname: Ibrahim
authors.forename: John E
authors.initials: JE
authors.lastname: Edwards
authors.forename: Richard
authors.initials: R
authors.lastname: Bryant
authors.forename: Brad
authors.initials: B
authors.lastname: Spellberg
mesh_terms: D017281:Cost of Illness; D005657:Fungal Vaccines / Q000191:economics*; D017048:Health Care Costs; D006801:Humans; D017059:Models, Econometric; D009090:Mucorales; D009091:Mucormycosis / Q000191:economics* / Q000401:mortality; D012189:Retrospective Studies; D014481:United States
chemical_list: D005657:Fungal Vaccines
references.citation: Clin Infect Dis. 2002 Apr 1;34(7):909-17
references.pmid: 11880955
references.citation: Am J Respir Crit Care Med. 2001 May;163(6):1389-94
references.pmid: 11371406
references.citation: N Engl J Med. 2002 Sep 26;347(13):993-1000
references.pmid: 12324556
references.citation: Clin Infect Dis. 1998 Nov;27(5):1138-47
references.pmid: 9827260
references.citation: Bone Marrow Transplant. 1999 Aug;24(3):307-12
references.pmid: 10455371
references.citation: Diabetes Res Clin Pract. 2007 Apr;76(1):51-6
references.pmid: 16959363
references.citation: Clin Infect Dis. 2008 Aug 1;47(3):364-71
references.pmid: 18558882
references.citation: Vaccine. 2001 Feb 8;19(13-14):1559-66
references.pmid: 11166875
references.citation: N Engl J Med. 2004 Feb 26;350(9):950-2
references.pmid: 14985500
references.citation: J Infect Dis. 2005 Apr 15;191(8):1350-60
references.pmid: 15776383
references.citation: Crit Care Med. 2000 Nov;28(11):3599-605
references.pmid: 11098960
references.citation: Arch Dis Child. 2004 Feb;89(2):188-94
references.pmid: 14736641
references.citation: Health Care Manag Sci. 2004 Feb;7(1):43-9
references.pmid: 14977093
references.citation: Clin Microbiol Rev. 2000 Apr;13(2):236-301
references.pmid: 10756000
references.citation: Cancer. 2005 May 1;103(9):1916-24
references.pmid: 15751024
references.citation: Clin Infect Dis. 2000 Jun;30(6):851-6
references.pmid: 10852735
references.citation: Diabetes Res Clin Pract. 2006 Oct;74(1):82-9
references.pmid: 16621109
references.citation: Leuk Lymphoma. 2004 Jul;45(7):1351-60
references.pmid: 15359632
references.citation: JAMA. 1999 Jan 27;281(4):354-60
references.pmid: 9929089
references.citation: Bone Marrow Transplant. 2003 Mar;31(6):417-21
references.pmid: 12665834
references.citation: Clin Infect Dis. 2005 Sep 1;41(5):634-53
references.pmid: 16080086
references.citation: Am J Med Sci. 2006 May;331(5):243-51
references.pmid: 16702793
references.citation: Clin Microbiol Rev. 2005 Jul;18(3):556-69
references.pmid: 16020690
references.citation: JAMA. 1997 Apr 2;277(13):1058-63
references.pmid: 9091694
references.citation: Expert Opin Biol Ther. 2007 Dec;7(12):1785-8
references.pmid: 18034644
references.citation: Curr Opin Infect Dis. 2004 Dec;17(6):517-25
references.pmid: 15640705