title: Cost of invasive fungal infections in the era of new diagnostics and expanded treatment options.
abstract: OBJECTIVE
  To determine the true institutional cost of treating invasive fungal infections in light of recent advances in diagnostic techniques and antifungal therapies for both treatment and prophylaxis of these infections.
  
  
  METHODS
  Economic analysis.
  
  
  METHODS
  Academic medical center.
  
  
  METHODS
  A total of 200 patients discharged from the hospital during 2004-2005 with a diagnosis of proven, probable, or possible aspergillosis, cryptococcosis, invasive candidiasis, or zygomycosis (cases). Patients were matched in a 1:1 fashion with patients having similar underlying disease states but no invasive fungal infections (controls).
  
  
  RESULTS
  Data on demographic and clinical characteristics were collected from patients' medical records. In addition, information concerning each patient's hospitalization was recorded. Resource utilization data for a patient's entire hospitalization were collected from the hospital's charge databases and converted to costs. These data were compared between the cases and the controls. After adjusting for race-ethnicity, sex, age, and comorbid illnesses, mean total hospital cost for cases was $32,196 more than for controls (p<0.0001). Nonpharmacy costs accounted for the majority (63%) of this difference, and an additional $3996 was attributed to systemic antifungal drugs. The mean length of hospital stay was longer for cases than controls (25.8 vs 18.4 days).
  
  
  CONCLUSIONS
  Treatment of patients with invasive fungal infections was associated with a significantly higher inpatient hospital cost compared with controls. However, due to new diagnostic techniques and effective antifungal therapy, the relative cost of these infections appears to be at least stable compared with the previous decade. These findings can help assess the utility of cost-avoidance strategies such as antifungal prophylaxis and application of appropriate treatment.
authors.affiliation: Division of Infectious Diseases and International Health, Department of Medicine, Duke University Medical Center, Durnham, North Carolina, USA. Elizabeth_doddsashley@urmc.rochester.edu
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Dodds Ashley
authors.forename: Richard
authors.initials: R
authors.lastname: Drew
authors.forename: Melissa
authors.initials: M
authors.lastname: Johnson
authors.forename: Robert
authors.initials: R
authors.lastname: Danna
authors.forename: Dominika
authors.initials: D
authors.lastname: Dabrowski
authors.forename: Valery
authors.initials: V
authors.lastname: Walker
authors.forename: Manishi
authors.initials: M
authors.lastname: Prasad
authors.forename: Barbara
authors.initials: B
authors.lastname: Alexander
authors.forename: George
authors.initials: G
authors.lastname: Papadopoulos
authors.forename: John
authors.initials: J
authors.lastname: Perfect
mesh_terms: D000046:Academic Medical Centers; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000935:Antifungal Agents / Q000191:economics / Q000627:therapeutic use*; D001228:Aspergillosis / Q000188:drug therapy / Q000191:economics / Q000503:physiopathology / Q000628:therapy*; D058365:Candidiasis, Invasive / Q000188:drug therapy / Q000191:economics / Q000628:therapy*; D003453:Cryptococcosis / Q000188:drug therapy / Q000191:economics / Q000503:physiopathology / Q000628:therapy*; D016527:Drug Costs; D005260:Female; D017721:Hospital Costs; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009657:North Carolina; D012720:Severity of Illness Index; D055815:Young Adult; D020096:Zygomycosis / Q000188:drug therapy / Q000191:economics / Q000503:physiopathology / Q000628:therapy
chemical_list: D000935:Antifungal Agents