title: Prospective evaluation of the cost of diagnosis and treatment of invasive fungal disease in a cohort of adult haematology patients in the UK.
abstract: OBJECTIVE
  The direct cost of invasive fungal disease (IFD) includes antifungal drugs as well as diagnostic tests. The aim of this study was to determine these costs.
  
  
  METHODS
  A total of 203 haematology patients were enrolled into the study and followed for a median of 556 days. Data were prospectively collected on antifungal drugs, diagnostic tests, length of stay and antibiotic usage.
  
  
  RESULTS
  The overall mean (IQR) cost of care per patient (using UK-based reference costs) was £88 911 (45 339-121 594), £61 509 (39 748-78 383), £50 332 (23 037-72 057) and £34 075 (19 928-43 900) for proven/probable IFD, possible IFD, not classified and no evidence of IFD, respectively (P<0.001). The attributable cost of IFD was £54 836. Inpatient hospital stay accounted for nearly 74% of costs. In proven/probable IFD inpatient care, antifungals, antibiotics and IFD status accounted for 68%, 25%, 5% and 2%, respectively, compared with 85%, 11%, 2% and 2%, respectively, for no IFD (P<0.001). Among the allogeneic transplant patients, £36 914 (60%) of the total cost (£60 917) was used during the first 100 days.
  
  
  CONCLUSIONS
  IFD was associated with longer length of stay and higher total overall cost of care, with attributable costs greater than £50 000 per case of IFD. Costs for inpatient stay far outstrip the cost of antifungal agents.
authors.affiliation: Department of Haematological Medicine, Kings College Hospital NHS Foundation Trust, Denmark Hill, London SE5 9RS, UK mansour.ceesay@nhs.net.
authors.forename: M Mansour
authors.initials: MM
authors.lastname: Ceesay
authors.affiliation: Aquarius Population Health, Bristol, UK.
authors.forename: Zia
authors.initials: Z
authors.lastname: Sadique
authors.affiliation: Public Health England, Colindale, London, UK.
authors.forename: Ross
authors.initials: R
authors.lastname: Harris
authors.affiliation: Aquarius Population Health, Bristol, UK.
authors.forename: Alice
authors.initials: A
authors.lastname: Ehrlich
authors.affiliation: Aquarius Population Health, Bristol, UK School of Social and Community Medicine, University of Bristol, Bristol, UK.
authors.forename: Elisabeth J
authors.initials: EJ
authors.lastname: Adams
authors.affiliation: Department of Haematological Medicine, Kings College Hospital NHS Foundation Trust, Denmark Hill, London SE5 9RS, UK.
authors.forename: Antonio
authors.initials: A
authors.lastname: Pagliuca
mesh_terms: D000328:Adult; D000368:Aged; D000935:Antifungal Agents / Q000191:economics* / Q000627:therapeutic use; D003955:Diagnostic Tests, Routine / Q000191:economics* / Q000379:methods; D004363:Drug Utilization; D005260:Female; D017048:Health Care Costs; D019337:Hematologic Neoplasms / Q000150:complications*; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009181:Mycoses / Q000175:diagnosis* / Q000188:drug therapy*; D011446:Prospective Studies; D006113:United Kingdom; D055815:Young Adult
chemical_list: D000935:Antifungal Agents
keywords: antifungals; attributable cost; diagnostic tests; length of stay