Monetary costs and hospital burden associated with the management of invasive fungal infections in Mexico: a multicenter study

Background: Invasive fungal infections (IFIs) affect >1.5 million people per year. Nevertheless, IFIs are usually neglected and underdiagnosed. IFIs should be considered as a public-health problem and major actions should be taken to tackle them and their associated costs. Aim To report the incid...

Full description

Bibliographic Details
Main Authors: Corzo León, Dora Edith, Perales Martínez, Diana, Martin Onraet, Alexandra, Rivera Martínez, Norma, Camacho Ortiz, Adrián, Villanueva Lozano, Hiram
Format: Article
Language:English
Published: Elsevier 2018
Subjects:
Online Access:http://eprints.uanl.mx/23968/1/23968.pdf
_version_ 1824417074260213760
author Corzo León, Dora Edith
Perales Martínez, Diana
Martin Onraet, Alexandra
Rivera Martínez, Norma
Camacho Ortiz, Adrián
Villanueva Lozano, Hiram
author_facet Corzo León, Dora Edith
Perales Martínez, Diana
Martin Onraet, Alexandra
Rivera Martínez, Norma
Camacho Ortiz, Adrián
Villanueva Lozano, Hiram
author_sort Corzo León, Dora Edith
collection Repositorio Institucional
description Background: Invasive fungal infections (IFIs) affect >1.5 million people per year. Nevertheless, IFIs are usually neglected and underdiagnosed. IFIs should be considered as a public-health problem and major actions should be taken to tackle them and their associated costs. Aim To report the incidence of IFIs in four Mexican hospitals, to describe the economic cost associated with IFIs therapy and the impact of adverse events such as acute kidney injury (AKI), liver damage (LD), and ICU stay. Methods: This was a retrospective, transversal study carried-out in four Mexican hospitals. All IFIs occurring during 2016 were included. Incidence rates and estimation of antifungal therapy's expenditure for one year were calculated. Adjustments for costs of AKI were done. An analysis of factors associated with death, AKI, and LD was performed. Results: Two-hundred thirty-eight cases were included. Among all cases, AKI was diagnosed in 16%, LD in 25%, 35% required ICU stay, with a 23% overall mortality rate. AKI and LD showed higher mortality rates (39% vs 9% and 44% vs 18%, respectively, p < 0.0001). The overall incidence of IFIs was 4.8 cases (95% CI = 0.72–8.92) per 1000 discharges and 0.7 cases (95% CI = 0.03–1.16) per 1000 patients-days. Invasive candidiasis showed the highest incidence rate (1.93 per 1000 discharges, 95% CI = −1.01 to 2.84), followed by endemic IFIs (1.53 per 1000 discharges 95% CI = −3.36 to 6.4) and IA (1.25 per 1000 discharges, 95% CI = −0.90 to 3.45). AKI increased the cost of antifungal therapy 4.3-fold. The total expenditure in antifungal therapy for all IFIs, adjusting for AKI, was $233,435,536 USD (95% CI $6,224,993 to $773,810,330). Conclusions: IFIs are as frequent as HIV asymptomatic infection and tuberculosis. Costs estimations allow to assess cost-avoidance strategies to increase targeted driven therapy and decrease adverse events and their costs.
format Article
id eprints-23968
institution UANL
language English
publishDate 2018
publisher Elsevier
record_format eprints
spelling eprints-239682022-09-30T20:24:30Z http://eprints.uanl.mx/23968/ Monetary costs and hospital burden associated with the management of invasive fungal infections in Mexico: a multicenter study Corzo León, Dora Edith Perales Martínez, Diana Martin Onraet, Alexandra Rivera Martínez, Norma Camacho Ortiz, Adrián Villanueva Lozano, Hiram RC Medicina Interna, Psiquiatría, Neurología Background: Invasive fungal infections (IFIs) affect >1.5 million people per year. Nevertheless, IFIs are usually neglected and underdiagnosed. IFIs should be considered as a public-health problem and major actions should be taken to tackle them and their associated costs. Aim To report the incidence of IFIs in four Mexican hospitals, to describe the economic cost associated with IFIs therapy and the impact of adverse events such as acute kidney injury (AKI), liver damage (LD), and ICU stay. Methods: This was a retrospective, transversal study carried-out in four Mexican hospitals. All IFIs occurring during 2016 were included. Incidence rates and estimation of antifungal therapy's expenditure for one year were calculated. Adjustments for costs of AKI were done. An analysis of factors associated with death, AKI, and LD was performed. Results: Two-hundred thirty-eight cases were included. Among all cases, AKI was diagnosed in 16%, LD in 25%, 35% required ICU stay, with a 23% overall mortality rate. AKI and LD showed higher mortality rates (39% vs 9% and 44% vs 18%, respectively, p < 0.0001). The overall incidence of IFIs was 4.8 cases (95% CI = 0.72–8.92) per 1000 discharges and 0.7 cases (95% CI = 0.03–1.16) per 1000 patients-days. Invasive candidiasis showed the highest incidence rate (1.93 per 1000 discharges, 95% CI = −1.01 to 2.84), followed by endemic IFIs (1.53 per 1000 discharges 95% CI = −3.36 to 6.4) and IA (1.25 per 1000 discharges, 95% CI = −0.90 to 3.45). AKI increased the cost of antifungal therapy 4.3-fold. The total expenditure in antifungal therapy for all IFIs, adjusting for AKI, was $233,435,536 USD (95% CI $6,224,993 to $773,810,330). Conclusions: IFIs are as frequent as HIV asymptomatic infection and tuberculosis. Costs estimations allow to assess cost-avoidance strategies to increase targeted driven therapy and decrease adverse events and their costs. Elsevier 2018 Article PeerReviewed text en cc_by_nc_nd http://eprints.uanl.mx/23968/1/23968.pdf http://eprints.uanl.mx/23968/1.haspreviewThumbnailVersion/23968.pdf Corzo León, Dora Edith y Perales Martínez, Diana y Martin Onraet, Alexandra y Rivera Martínez, Norma y Camacho Ortiz, Adrián y Villanueva Lozano, Hiram (2018) Monetary costs and hospital burden associated with the management of invasive fungal infections in Mexico: a multicenter study. The Brazilian Journal of Infectious Diseases, 22 (5). pp. 360-370. ISSN 14138670
spellingShingle RC Medicina Interna, Psiquiatría, Neurología
Corzo León, Dora Edith
Perales Martínez, Diana
Martin Onraet, Alexandra
Rivera Martínez, Norma
Camacho Ortiz, Adrián
Villanueva Lozano, Hiram
Monetary costs and hospital burden associated with the management of invasive fungal infections in Mexico: a multicenter study
thumbnail https://rediab.uanl.mx/themes/sandal5/images/online.png
title Monetary costs and hospital burden associated with the management of invasive fungal infections in Mexico: a multicenter study
title_full Monetary costs and hospital burden associated with the management of invasive fungal infections in Mexico: a multicenter study
title_fullStr Monetary costs and hospital burden associated with the management of invasive fungal infections in Mexico: a multicenter study
title_full_unstemmed Monetary costs and hospital burden associated with the management of invasive fungal infections in Mexico: a multicenter study
title_short Monetary costs and hospital burden associated with the management of invasive fungal infections in Mexico: a multicenter study
title_sort monetary costs and hospital burden associated with the management of invasive fungal infections in mexico a multicenter study
topic RC Medicina Interna, Psiquiatría, Neurología
url http://eprints.uanl.mx/23968/1/23968.pdf
work_keys_str_mv AT corzoleondoraedith monetarycostsandhospitalburdenassociatedwiththemanagementofinvasivefungalinfectionsinmexicoamulticenterstudy
AT peralesmartinezdiana monetarycostsandhospitalburdenassociatedwiththemanagementofinvasivefungalinfectionsinmexicoamulticenterstudy
AT martinonraetalexandra monetarycostsandhospitalburdenassociatedwiththemanagementofinvasivefungalinfectionsinmexicoamulticenterstudy
AT riveramartineznorma monetarycostsandhospitalburdenassociatedwiththemanagementofinvasivefungalinfectionsinmexicoamulticenterstudy
AT camachoortizadrian monetarycostsandhospitalburdenassociatedwiththemanagementofinvasivefungalinfectionsinmexicoamulticenterstudy
AT villanuevalozanohiram monetarycostsandhospitalburdenassociatedwiththemanagementofinvasivefungalinfectionsinmexicoamulticenterstudy