Delays in Coccidioidomycosis Diagnosis and Relationship to Healthcare Utilization, Arizona, USA<sup>1</sup>

Ginn, Rachel; Mohty, Ralph; Bollmann, Keri Lyn; Goodsell, Jessica; Méndez, Guillermo; Bradley, Barrie; Galgiani, John N.

doi:10.3201/eid2509.190019

Cited by 10 publications

(6 citation statements)

References 8 publications

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“…Like others, we believe that a significant number of patients with primary coccidioidal pneumonia are not diagnosed by current clinical practice [ 24 , 25 ]. Moreover, recent studies demonstrate significant delays in diagnosis, which lead to increased costs [ 12 , 13 , 14 ]. Valley fever-related charges for patients with any delay (≥1 day) were significantly greater than for those diagnosed on the day they presented with symptoms [ 13 ].…”

Section: Discussionmentioning

confidence: 99%

“…Moreover, recent studies demonstrate significant delays in diagnosis, which lead to increased costs [ 12 , 13 , 14 ]. Valley fever-related charges for patients with any delay (≥1 day) were significantly greater than for those diagnosed on the day they presented with symptoms [ 13 ]. Although the workup costs in our study included some rule-out testing, it is likely our results underestimate the additional costs associated with delayed diagnosis.…”

Section: Discussionmentioning

confidence: 99%

“…There has been little commercial incentive to develop new more sensitive and rapid diagnostic tests [ 10 ], curative therapies [ 4 ], or preventative vaccines [ 11 ]. Even within the endemic regions, standard medical practice results in surprisingly frequent delays in diagnosis, which also contributes to the impact of the disease [ 12 , 13 , 14 ].…”

mentioning

confidence: 99%

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Clinical and Economic Burden of Valley Fever in Arizona: An Incidence-Based Cost-of-Illness Analysis

Grizzle

Wilson

Nix

et al. 2020

Open Forum Infectious Diseases

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Background Coccidioidomycosis, ie, Valley fever, is an important fungal infection in the Southwest, with half to two thirds of all cases occurring in Arizona. This endemic respiratory disease can range from primary uncomplicated pneumonia to disseminated infection such as meningitis with chronic pulmonary complications. Valley fever diagnoses have risen over recent years and cause substantial morbidity and economic burden in Arizona. Methods We estimated the lifetime cost-of-illness associated with all cases of Valley fever diagnosed in 2019 in Arizona. Natural history of the disease was determined from literature and expert opinion and assigned costs from national data sources to determine lifetime direct and indirect costs (work loss). Results Total lifetime costs of $736 million were estimated for the 10 359 cases of Valley fever diagnosed in Arizona in 2019. Direct costs of $671 million accounted for over 90% of expenditures, with $65 million in indirect costs. Disseminated infection produces the highest economic burden at $1.26 million direct and $137 400 indirect costs per person. The lowest Valley fever lifetime costs were for cases of primary uncomplicated pneumonia with $23 200 in direct costs and $1300 in lost wages. The average lifetime direct costs across all Valley fever manifestations are $64 800 per person diagnosed in Arizona in 2019 and $6300 for indirect costs. Conclusions Valley fever is responsible for substantial economic burden in Arizona. Our estimates underscore the value of supporting research into developing more rapid diagnostic tests, better therapies, and ultimately a preventative vaccine to address this important public health problem in Arizona.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Clinical and Economic Burden of Valley Fever in Arizona: An Incidence-Based Cost-of-Illness Analysis

Grizzle

Wilson

Nix

et al. 2020

Open Forum Infectious Diseases

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“…found a comparable missed diagnosis rate of 25% for tuberculosis [22] utilizing HCUP data from both inpatient and emergency department encounters [23] . Similarly, in two studies examining missed opportunities in coccidioidomycosis, diagnosis was delayed by more than a month in 46% and 43% of patients [ 24 , 25 ]. In smaller cohorts of patients with cryptococcal infection, missed opportunities for diagnosis have been shown to be associated with delayed initiation of treatment, ultimately leading to further dissemination and progression of disease, permanent neurological deficits, and higher all-cause [3] and disease-specific mortality [ 3 , 4 ].…”

Section: Discussionmentioning

confidence: 99%

Potential missed opportunities for diagnosis of cryptococcosis and the association with mortality: A cohort study

et al. 2020

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Background Cryptococcosis is one of the most common life-threatening opportunistic mycoses worldwide. Insidious presentation and slow onset of symptoms make it difficult to recognize, complicating the diagnostic process. Delays in diagnosis may lead to increased mortality. We aim to determine the frequency of missed opportunities for diagnosis of cryptococcosis and its effects on mortality. Methods To estimate the proportion of individuals with a potentially missed diagnosis for cryptococcosis in hospitalized patients, we conducted a retrospective cohort study using the Healthcare Cost and Utilization Project State Inpatient Databases from 2005 to 2015 from eight states. All hospitalized adult patients diagnosed with cryptococcal infection or cryptococcal meningitis were included. Potentially missed diagnoses were defined as admissions coded for a procedure or diagnosis suggestive of cryptococcosis in the 90-days prior to the initial cryptococcosis admission. Generalized estimating equations models were used to evaluate the association between underlying comorbidities and potential missed diagnosis of cryptococcosis and 90-day all-cause in-hospital mortality. Findings Of 5,354 patients with cryptococcosis, 2,445 (45·7%) were people living with HIV (PLWH). Among PLWH, 493/2,445 (20·2%) had a potentially missed diagnosis, of which 83/493 (16·8%) died while hospitalized compared with 265/1,952 (13·6%) of those without a potentially missed diagnosis (relative risk [RR] 1·04, 95% CI 0·99–1·09). Among HIV-negative patients, 977/2,909 (33·6%) had a potentially missed diagnosis, of which 236/977 (24·2%) died while hospitalized compared with 298/1,932 (15·4%) of those not missed (RR 1·12, 95% CI 1·07–1·16). Interpretation Missed opportunities to diagnose cryptococcosis are common despite highly efficacious diagnostic tests and are associated with increased risk of 90-day mortality in HIV-negative patients. A high index of clinical suspicion is paramount to promptly diagnose, treat, and improve cryptococcosis-related mortality. Funding National Center for Advancing Translational Sciences, Washington University Institute of Clinical and Translational Sciences, and the Agency for Healthcare Research and Quality.

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“…At such time as these tests become available, studies of this may be valuable. Resolving such questions is facilitated by utilizing the expanding ability of electronic medical records (EMRs) to mine data and perform analytics to ascertain if new tests, such as the LFA, or clinical interventions actually have the desired effects of improved antibiotic stewardship, providing better patient outcomes, or lowering health care costs (178)(179)(180).…”

Section: Clinical Aspects Of Coccidioidomycosismentioning

confidence: 99%

Early Events in Coccidioidomycosis

et al. 2019

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SUMMARY Since its description nearly 130 years ago, hundreds of studies have deepened our understanding of coccidioidomycosis, also known as valley fever (VF), and provided useful diagnostic tests and treatments for the disease caused by the dimorphic fungi Coccidioides spp. In general, most of the literature has addressed well-established infections and has described patients who have experienced major complications. In contrast, little attention has been given to the earliest consequences of the pathogen-host interaction and its implications for disease manifestation, progression, and resolution. The purpose of this review is to highlight published studies on early coccidioidomycosis, identify gaps in our knowledge, and suggest new or former research areas that might be or remain fertile ground for insight into the early stages of this invasive fungal disease.

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Delays in Coccidioidomycosis Diagnosis and Relationship to Healthcare Utilization, Arizona, USA¹

Cited by 10 publications

References 8 publications

Clinical and Economic Burden of Valley Fever in Arizona: An Incidence-Based Cost-of-Illness Analysis

Clinical and Economic Burden of Valley Fever in Arizona: An Incidence-Based Cost-of-Illness Analysis

Potential missed opportunities for diagnosis of cryptococcosis and the association with mortality: A cohort study

Early Events in Coccidioidomycosis

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Delays in Coccidioidomycosis Diagnosis and Relationship to Healthcare Utilization, Arizona, USA1

Cited by 10 publications

References 8 publications

Clinical and Economic Burden of Valley Fever in Arizona: An Incidence-Based Cost-of-Illness Analysis

Clinical and Economic Burden of Valley Fever in Arizona: An Incidence-Based Cost-of-Illness Analysis

Potential missed opportunities for diagnosis of cryptococcosis and the association with mortality: A cohort study

Early Events in Coccidioidomycosis

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Delays in Coccidioidomycosis Diagnosis and Relationship to Healthcare Utilization, Arizona, USA¹