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Cost analysis of bronchoalveolar lavage and respiratory tract biopsies in the diagnosis and management of suspected invasive fungal infection in children with cancer or who have undergone stem cell transplant
Author(s) -
Rossoff Jenna,
Locke Margaret,
Helenowski Irene B.,
Batra Surabhi,
Katz Ben Z.,
Hijiya Nobuko
Publication year - 2019
Publication title -
pediatric blood and cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.116
H-Index - 105
eISSN - 1545-5017
pISSN - 1545-5009
DOI - 10.1002/pbc.27598
Subject(s) - medicine , bronchoalveolar lavage , hematopoietic stem cell transplantation , institutional review board , population , biopsy , cancer , respiratory tract , surgery , respiratory system , radiology , transplantation , lung , environmental health
Background Identification of an organism is the gold standard for the diagnosis of fungal infection; however, we have previously shown that invasive procedures infrequently lead to a change in management in children with cancer or who have undergone stem cell transplant with suspected respiratory tract invasive fungal infection (RT‐IFI). There is also a paucity of data on the cost of RT‐IFI in this population. We therefore compared the costs of RT‐IFI diagnosed based on CT scan alone versus those who underwent a bronchoalveolar lavage (BAL) or respiratory tract biopsy (RTB). Procedure We collected cost data on patients at a single center undergoing chemotherapy or who were post‐hematopoietic stem cell transplant (HSCT) and were suspected of having RT‐IFI between 2007 and 2012. Cost data were included for 14 days from the day of their diagnostic CT scan or procedure. Results Cost data were available for 76 patients. Thirty‐six patients were diagnosed with suspected RT‐IFI based on CT only, and 40 patients underwent BAL or RTB. Costs related to chest X‐rays (CXRs), inpatient/intensive care unit (ICU) beds, anesthesia, operating room (OR) time, and procedures were significantly higher in the BAL/RTB group versus CT scan group (all P < 0.01). Costs related to CT scans were significantly higher in the CT scan group ( P = 0.0002). Overall costs were significantly higher for patients who underwent BAL or RTB versus CT scan only ( P < 0.0001). Conclusion Our previous data showed that BAL and RTB infrequently led to a change in management in this population. We now demonstrate that this strategy is costly as well.