Grizzle Amy J, Wilson Leslie, Nix David E, Galgiani John N
Center for Health Outcomes & PharmacoEconomic Research, University of Arizona College of Pharmacy, Tucson, Arizona, USA.
Department of Clinical Pharmacy, University of California, San Francisco, California, USA.
Open Forum Infect Dis. 2020 Dec 28;8(2):ofaa623. doi: 10.1093/ofid/ofaa623. eCollection 2021 Feb.
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.
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).
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.
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.
球孢子菌病，即山谷热，是美国西南部一种重要的真菌感染，所有病例中有一半至三分之二发生在亚利桑那州。这种地方性呼吸道疾病的范围从原发性无并发症肺炎到播散性感染，如伴有慢性肺部并发症的脑膜炎。近年来，山谷热的诊断病例有所增加，给亚利桑那州带来了巨大的发病率和经济负担。
我们估算了2019年亚利桑那州诊断出的所有山谷热病例的终身疾病成本。根据文献和专家意见确定疾病的自然史，并从国家数据来源分配成本，以确定终身直接和间接成本（工作损失）。
2019年亚利桑那州诊断出的10359例山谷热病例的终身总成本估计为7.36亿美元。直接成本为6.71亿美元，占支出的90%以上，间接成本为6500万美元。播散性感染产生的经济负担最高，每人直接成本为126万美元，间接成本为13.74万美元。原发性无并发症肺炎病例的山谷热终身成本最低，直接成本为23200美元，工资损失为1300美元。2019年亚利桑那州所有山谷热表现的平均终身直接成本为每人64800美元，间接成本为6300美元。
山谷热给亚利桑那州带来了巨大的经济负担。我们的估计强调了支持开展研究以开发更快速的诊断测试、更好的治疗方法以及最终开发预防性疫苗的价值，以解决亚利桑那州这一重要的公共卫生问题。
