Table 1.
Direct Lifetime Costs per Person Diagnosed in 2019 in Arizona by Valley Fever Disease Manifestationa
| Disease and Cost Type | Item | Healthcare Utilization | Average per Person Lifetime Cost |
|---|---|---|---|
| Primary Uncomplicated Pneumonia | |||
| Pre-Valley Fever Diagnosis | |||
| Physician visit | 100% had 3 physician visits | $491 | |
| ER visit | 23% first sought care in ER | $18a | |
| Medication | Azithromycin/levofloxacin | 100% (50% require 2nd course) | $106 |
| Diagnosis | Immunodiffusion and titer | 100% (25% require repeat testing) | |
| Chest x-ray | 100% | $338 | |
| Chest CT | 25% | ||
| Others, HIV testing | 100% | ||
| Post-Valley fever diagnosis | |||
| Hospitalization | Requiring hospitalization | 40% | |
| 1 lifetime hospitalization | 90% | $14 868 | |
| 2 lifetime hospitalizations | 7% | ||
| >2 lifetime hospitalizations | 3% | ||
| Medication | Fluconazole (400 mg/day) | 90% (6 months) | |
| Itraconazole (200 mg twice/day) | 3% (6 months) | $6134 | |
| Liposomal amphotericin B (5 mg/kg per day) | 2% (for pregnant women, 6 months) | ||
| Voriconazole (200 mg twice/day) | 5% (after failing fluconazole/voriconazole, 6 months) | ||
| Follow-up | Immunodiffusion and titer | 100% every 3 months for 12 months | |
| Chest x-ray | (expected compliance 50%–80%) | $1238 | |
| Home care/nursing home | None | $0 | |
| Total | $23 192 | ||
| Chronic Pneumonia | |||
| Pre-Valley fever diagnosis | Same as for primary uncomplicated pneumonia | $615 | |
| Other medication | 4-drug regimen for tuberculosis (rifampin 600 mg/day, isoniazid 300 mg/day, pyrazinamide 1500 mg/day, ethambutol 1200 mg/day) | 10% (1 month) | $53 |
| Diagnosis | Immunodiffusion and titer | 100% (25% require repeat testing) | |
| Chest x-ray | 50% have 2 x-rays/year outside of hospital | $337 | |
| Chest CT | 30% have chest CT outside of hospital | ||
| Post-Valley Fever Diagnosis | |||
| Hospitalization | 1st hospitalization in year 1 | 75% | |
| 2nd hospitalization in year 1 | 65% (of those with 1st hospitalization) | $73 600 | |
| 1 future lifetime hospitalization | 100% | ||
| Medication | Fluconazole (800 mg/day) | 75% (36 months) | $47 443 |
| Itraconazole (200 mg twice/day) | 25% (36 months) | ||
| Follow-up | Immunodiffusion and titer | 100% every 3 months for 12 months | |
| (expected compliance 50%–80%) | $1642 | ||
| Chest x-ray and chest CT | 100% (at discharge, expected compliance 50%–80%) | ||
| Home care | 100% (3 days a week for 3 months) | $2569 | |
| Rehabilitation facility | 100% (30 days) | $3774 | |
| Total | $130 033 | ||
| Disseminated Infection | |||
| Pre-Valley fever diagnosis | Same as for primary uncomplicated pneumonia | $614 | |
| Diagnosis | |||
| Immunodiffusion/titer/chest x-ray/chest CT | Same as for chronic pneumonia | ||
| Lumbar puncture | 50% | ||
| MRI | 15%–20% | ||
| Aspirates of joint effusions | 10% | ||
| Skin biopsy | 10% | $773 | |
| Bone marrow biopsy | 5% | ||
| Lung biopsy | 20% | ||
| Lymph node biopsy | 20% | ||
| Liver biopsy | 5% | ||
| Post-Valley Fever Diagnosis | |||
| Hospitalization | 1st hospitalization in year 1 | 100% | |
| 2nd hospitalization in year 1 | 65% (of those with 1st hospitalization) | $915 959 | |
| Hospitalization in year 2 | 100% hospitalized once a year for life | ||
| Medication | Fluconazole (800 mg/day) | 98% (lifelong) | $315 975 |
| Liposomal amphotericin B (5 mg/kg per day) | 2% (lifelong) | ||
| Other treatment considerations | Ventriculoperitoneal shunt placement | 15% of those with meningitis | $864 |
| Ventriculoperitoneal shunt replacement | 100% of shunts replaced once in lifetime | ||
| Follow-up | Immunodiffusion and titer | ||
| Chest x-ray | 100% (every 3 months in year 1, every 6 months for life; MRI every 6 months for life; lumbar puncture 2 times in year 1, times in lifetime; expected compliance 50%–80%) | $17 697 | |
| Chest CT | |||
| Liver function test | |||
| Renal function test | |||
| MRI | |||
| Lumbar puncture | |||
| Home care | 100% (3 days a week for 3 months) | $2569 | |
| Nursing home | Temporary stay | 10% (2 months) | $763 |
| Total | $1 262 414 | ||
| Other Pulmonary Changes: Pulmonary Nodules | |||
| Pre-Valley fever diagnosis | Same as for primary uncomplicated pneumonia | $614 | |
| Diagnosis | Immunodiffusion and titer | 100% (25% require repeat testing) | $80 352 |
| Chest x-ray | 100% | ||
| Chest CT | 25% | ||
| Diagnostic workup for lung cancer (CT scan, and biopsy if indeterminate) | 90% | ||
| Post-Valley Fever Diagnosis | |||
| Hospitalization | Same as for primary uncomplicated pneumonia | $14 868 | |
| Medication | Requiring medication | 25% | |
| Fluconazole (400 mg/day) | 90% (6 months) | $1198 | |
| Itraconazole (200 mg twice/day | 5% (6 months) | ||
| Voriconazole (200 mg twice/day) | 5% (after failing fluconazole/voriconazole, 6 months) | ||
| Follow-up | Immunodiffusion and titer | 100% every 3 months for 12 months, then every 6 months for 1 year (expected compliance 50%–80%) | $3735 |
| Chest x-ray | |||
| Home care/nursing home | None | $0 | |
| Total | $100 768 | ||
| Other Pulmonary Changes: Pulmonary Cavities | |||
| Pre-Valley Fever Diagnosis | |||
| Diagnosis | Same as for pulmonary nodule | $100 768 | |
| Post-Valley Fever Diagnosis | |||
| Additional Hospitalization | |||
| Cavity complications | 5% | $2936 | |
| Hemoptysis/chest pain | 5%–10% | $2467 | |
| Home care/nursing home | None | $0 | |
| Total | $106 171 |
Abbreviations: CT, computed tomography; ER, emergency room; HIV, human immunodeficency virus; MRI, magnetic resonance imaging.
aPre-Valley fever ER costs do not represent the associated medical doctor fees, which are included in the physician visit costs.