Hospital costs, length of stay and mortality attributable to invasive scedosporiosis in haematology patients.
BACKGROUND
Scedosporium species are increasingly recognized as a cause of invasive mould disease in haematology patients, but little is known about the hospitalization costs and outcomes attributable to invasive scedosporiosis (SCEDO).


METHODS
A retrospective case-control study was undertaken during 2002-10 to determine the attributable inpatient costs, length of stay (LOS) and mortality associated with SCEDO in haematology patients. Case patients with SCEDO (n = 30) were matched 1 : 2 to controls (n = 60) according to haematological diagnosis, admission year and age. Diagnostics, antifungal drugs, ward and other SCEDO-related costs were estimated using actual cost data. Median regression modelling was used to adjust for variables that were not accounted for in the matched-pairs analysis.


RESULTS
The crude total median cost of treating SCEDO was AU$32 182 per patient versus AU$17 424 per control. In multivariable analysis, SCEDO was associated with median excess costs of AU$23 611 (95% CI = AU$17 992-AU$29 231; P < 0.001), approximating US$15 509 at purchasing power parity, with prolonged LOS of 13 days (95% CI = 8.2-17.8 days; P < 0.001). Exclusion of cases and matched pairs with early death further increased the median excess cost and LOS. The cost differential was driven by ward costs (64%, P = 0.005) and antifungal treatment costs (29%, P < 0.001). The all-cause inpatient mortality was 38 times higher for the SCEDO cases versus the control group (63.3% versus 1.7%; P < 0.001).


CONCLUSIONS
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.
Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences,  Monash University, 381 Royal Parade, Parkville, Victoria 3052,  Australia.
Siow-Chin
SC
Heng
Monica A
MA
Slavin
Sharon C-A
SC
Chen
Christopher H
CH
Heath
Quoc
Q
Nguyen
Baki
B
Billah
Roger L
RL
Nation
David C M
DC
Kong
D000293:Adolescent; D000328:Adult; D000368:Aged; D000935:Antifungal Agents / Q000008:administration & dosage; D016022:Case-Control Studies; D005260:Female; D006402:Hematologic Diseases / Q000150:complications*; D017721:Hospital Costs / Q000706:statistics & numerical data*; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D009181:Mycoses / Q000188:drug therapy / Q000191:economics / Q000453:epidemiology* / Q000401:mortality; D012189:Retrospective Studies; D012307:Risk Factors; D021681:Scedosporium / Q000302:isolation & purification*; D016019:Survival Analysis; D014481:United States; D055815:Young Adult
D000935:Antifungal Agents