可能和确诊侵袭性毛霉菌病的医疗负担：2003 年至 2016 年期间在三级护理医院治疗的患者的多中心疾病成本分析。

Healthcare burden of probable and proven invasive mucormycosis: a multi-centre cost-of-illness analysis of patients treated in tertiary care hospitals between 2003 and 2016.

机构信息

University Hospital of Cologne, Department I of Internal Medicine, Cologne, Germany.

University Hospital of Cologne, Department I of Internal Medicine, Cologne, Germany; German Centre for Infection Research, Partner Site Bonn-Cologne, Cologne, Germany.

出版信息

J Hosp Infect. 2019 Mar;101(3):339-346. doi: 10.1016/j.jhin.2018.11.003. Epub 2018 Nov 10.

DOI:10.1016/j.jhin.2018.11.003

PMID:30423409

Abstract

BACKGROUND

Invasive mucormycosis (IM) is a rare invasive fungal infection with a high mortality rate. However, data concerning the clinical and economic burden of IM are scarce.

AIM

To evaluate the direct treatment costs and additional expenditures of patients with IM.

METHODS

A retrospective cost-of-illness analysis of cases with IM extracted from FungiScope - Global Registry for Emerging Fungal Infections, accessible through the epidemiological research platform www.ClinicalSurveys.net, was undertaken. Results of patients with IM were compared with those of matched patients with similar underlying conditions based on the German Diagnosis Related Group (G-DRG) coding.

FINDINGS

Out of 46 patients with probable/proven IM, 31 (67%) patients were male and the median age was 53 years (range 11-88 years). Forty-two patients (92%) had haematological diseases as the most common risk factor. Analysis of cost factors identified antifungal treatment due to IM as the primary cost driver [€22,816, 95% confidence interval (CI) €15,036-32,346], with mean overall direct treatment costs of €53,261 (95% CI €39,660-68,825). Compared with matched patients, patients with IM were treated in hospital for 26.5 additional days (standard deviation 31.8 days; P < 0.001), resulting in mean additional costs of €32,991 (95% CI €21,558-46,613; P < 0.001). Probable IM, as well as absence of chemotherapy, surgical measures due to IM, and antifungal prophylaxis were associated with lower overall costs. Nineteen patients (41.3%) died during hospitalization.

CONCLUSION

This study demonstrates the considerable healthcare burden of IM. The choice of antifungal agent for treatment of IM had no impact on overall cost.

摘要

背景

侵袭性毛霉菌病（IM）是一种罕见的侵袭性真菌感染，死亡率很高。然而，有关 IM 的临床和经济负担的数据很少。

目的

评估 IM 患者的直接治疗费用和额外支出。

方法

通过流行病学研究平台 www.ClinicalSurveys.net 上可访问的真菌学-全球新兴真菌感染登记处（FungiScope - Global Registry for Emerging Fungal Infections），对从该数据库中提取的侵袭性毛霉菌病病例进行回顾性疾病成本分析。将 IM 患者的结果与基于德国诊断相关组（G-DRG）编码的具有相似潜在疾病的匹配患者进行比较。

结果

在 46 例可能/确诊的 IM 患者中，31 例（67%）为男性，中位年龄为 53 岁（范围 11-88 岁）。42 例（92%）患者存在血液系统疾病，这是最常见的危险因素。成本因素分析确定抗真菌治疗是导致 IM 的主要成本驱动因素[22816 欧元，95%置信区间（CI）15036-32346 欧元]，总直接治疗费用平均为 53261 欧元（95%CI 39660-68825 欧元）。与匹配患者相比，IM 患者住院治疗时间增加 26.5 天（标准差 31.8 天；P<0.001），导致平均额外费用为 32991 欧元（95%CI 21558-46613 欧元；P<0.001）。可能的 IM 以及缺乏化疗、因 IM 而进行的手术措施和抗真菌预防与较低的总费用相关。19 例患者（41.3%）在住院期间死亡。