Hostname: page-component-cd9895bd7-gxg78 Total loading time: 0 Render date: 2024-12-18T19:43:16.308Z Has data issue: false hasContentIssue false
  • English
  • Français

Epidemiological Effectiveness and Cost of a Fungal Meningitis Outbreak Response in New River Valley, Virginia: Local Health Department and Clinical Perspectives

Published online by Cambridge University Press:  05 June 2017

Nargesalsadat Dorratoltaj ,
Margaret L. O’Dell ,
Paige Bordwine ,
Thomas M. Kerkering ,
Kerry J. Redican  and
Kaja M. Abbas
Nargesalsadat Dorratoltaj
Affiliation:
Department of Population Health Sciences, Virginia Tech, Blacksburg, Virginia
Margaret L. O’Dell
Affiliation:
New River Health District, Virginia Department of Health, Christiansburg, Virginia
Paige Bordwine
Affiliation:
New River Health District, Virginia Department of Health, Christiansburg, Virginia
Thomas M. Kerkering
Affiliation:
Division of Infectious Diseases, Virginia Tech Carilion School of Medicine, Roanoke, Virginia
Kerry J. Redican
Affiliation:
Department of Population Health Sciences, Virginia Tech, Blacksburg, Virginia
Kaja M. Abbas*
Affiliation:
Department of Population Health Sciences, Virginia Tech, Blacksburg, Virginia
*
Correspondence and reprint requests to Kaja M. Abbas, Department of Population Health Sciences, Virginia Tech, Blacksburg, VA 24061 (e-mail: [email protected]).
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective

We evaluated the effectiveness and cost of a fungal meningitis outbreak response in the New River Valley of Virginia during 2012-2013 from the perspective of the local public health department and clinical facilities. The fungal meningitis outbreak affected 23 states in the United States with 751 cases and 64 deaths in 20 states; there were 56 cases and 5 deaths in Virginia.

Methods

We conducted a partial economic evaluation of the fungal meningitis outbreak response in New River Valley. We collected costs associated with the local health department and clinical facilities in the outbreak response and estimated the epidemiological effectiveness by using disability-adjusted life years (DALYs) averted.

Results

We estimated the epidemiological effectiveness of this outbreak response to be 153 DALYs averted among the patients, and the costs incurred by the local health department and clinical facilities to be $30,413 and $39,580, respectively.

Conclusions

We estimated the incremental cost-effectiveness ratio of $198 per DALY averted and $258 per DALY averted from the local health department and clinical perspectives, respectively, thereby assisting in impact evaluation of the outbreak response by the local health department and clinical facilities. (Disaster Med Public Health Preparedness. 2018;12:38–46)

Keywords

cost-effectiveness analysisfungal meningitis outbreaklocal health departmentclinicalNew River ValleyVirginia
Type
Original Research
Information
Disaster Medicine and Public Health Preparedness , Volume 12 , Issue 1 , February 2018 , pp. 38 - 46
Copyright
Copyright © Society for Disaster Medicine and Public Health, Inc. 2017 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. Smith, RM, Schaefer, MK, Kainer, MA, et al. Fungal infections associated with contaminated methylprednisolone injections. N Engl J Med. 2013;369(17):1598-1609. https://doi.org/10.1056/NEJMoa1213978.Google Scholar
2. Kainer, MA, Reagan, DR, Nguyen, DB, et al. Fungal infections associated with contaminated methylprednisolone in Tennessee. N Engl J Med. 2012;367(23):2194-2203. https://doi.org/10.1056/NEJMoa1212972.Google Scholar
3. CDC. Multistate outbreak of fungal infection associated with injection of methylprednisolone acetate solution from a single compounding pharmacy – United States, 2012. MMWR Morb Mortal Wkly Rep. 2012;61(41):839-842.Google Scholar
4. Kauffman, CA, Pappas, PG, Patterson, TF. Fungal infections associated with contaminated methylprednisolone injections. N Engl J Med. 2013;368(26):2495-2500. https://doi.org/10.1056/NEJMra1212617.Google Scholar
5. Centers for Disease Control and Prevention. Multistate Outbreak of Fungal Meningitis and Other Infections. http://www.cdc.gov/hai/outbreaks/meningitis.html. CDC website. Accessed June 29, 2015.Google Scholar
6. Kerkering, TM, Grifasi, ML, Baffoe-Bonnie, AW, et al. Early clinical observations in prospectively followed patients with fungal meningitis related to contaminated epidural steroid injections. Ann Intern Med. 2013;158(3):154-161. https://doi.org/10.7326/0003-4819-158-3-201302050-00568.Google Scholar
7. Smith, RM, Derado, G, Wise, M, et al. Estimated deaths and illnesses averted during fungal meningitis outbreak associated with contaminated steroid injections, United States, 2012–2013. Emerging. Infect Dis J . 2015;21:933. http://dx.doi.org/10.3201/eid2106.141558.Google Scholar
8. New River Health District, Virginia Department of Health. Virginia.gov website. http://www.vdh.virginia.gov/LHD/index.htm. Accessed July 12, 2015.Google Scholar
9. Abbas, KM, Dorratoltaj, N, O’Dell, ML, et al. Economic evaluation of fungal meningitis outbreak response in New River Valley: local health department perspective. Front Public Health Serv Syst Res. 2015;4:21-28.Google Scholar
10. Abbas, KM, Dorratoltaj, N, O’Dell, ML, et al. Clinical response, outbreak investigation, and epidemiology of the fungal meningitis epidemic in the United States: systematic review. Disaster Med Public Health Prep. 2016;10(01):145-151. https://doi.org/10.1017/dmp.2015.137.Google Scholar
11. Murray, CJL, Vos, T, Lozano, R, et al. Disability-adjusted life years (DALYs) for 291 diseases and injuries in 21 regions, 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet. 2012;380(9859):2197-2223. https://doi.org/10.1016/S0140-6736(12)61689-4.CrossRefGoogle ScholarPubMed
12. CDC. Exophiala infection from contaminated injectable steroids prepared by a compounding pharmacy --- United States, July--November 2002. (2002). MMWR Weekly. 51(49):1109-1112. http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5149a1.htm. Published December 13, 2002. Accessed May 4, 2017.Google Scholar
13. WHO. Metrics: Disability-Adjusted Life Year (DALY). http://www.who.int/healthinfo/global_burden_disease/metrics_daly/en/. Accessed June 29, 2015.Google Scholar
14. Wang, H, Naghavi, M, Allen, C, et al; GBD 2015 Mortality and Causes of Death Collaborators. Global, regional, and national life expectancy, all-cause mortality, and cause-specific mortality for 249 causes of death, 1980-2015: a systematic analysis for the Global Burden of Disease Study 2015. Lancet. 2016;388(10053):1459-1544. https://doi.org/10.1016/S0140-6736(16)31012-1.Google Scholar
15. Vos, T, Allen, C, Arora, M, et al; GBD 2015 Disease and Injury Incidence and Prevalence Collaborators. Global, regional, and national incidence, prevalence, and years lived with disability for 310 diseases and injuries, 1990-2015: a systematic analysis for the Global Burden of Disease Study 2015. Lancet. 2016;388(10053):1545-1602. https://doi.org/10.1016/S0140-6736(16)31678-6.Google Scholar
16. Kassebaum, NJ, Arora, M, Barber, RM, et al; GBD 2015 DALYs and HALE Collaborators. Global, regional, and national disability-adjusted life-years (DALYs) for 315 diseases and injuries and healthy life expectancy (HALE), 1990-2015: a systematic analysis for the Global Burden of Disease Study 2015. Lancet. 2016;388(10053):1603-1658. https://doi.org/10.1016/S0140-6736(16)31460-X.Google Scholar
17. Forouzanfar, MH, Afshin, A, Alexander, LT, et al; GBD 2015 Risk Factors Collaborators. Global, regional, and national comparative risk assessment of 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks, 1990-2015: a systematic analysis for the Global Burden of Disease Study 2015. Lancet. 2016;388(10053):1659-1724. https://doi.org/10.1016/S0140-6736(16)31679-8.Google Scholar
18. Tung, CE, So, YT, Lansberg, MG. Cost comparison between the atraumatic and cutting lumbar puncture needles. Neurology. 2012;78(2):109-113. https://doi.org/10.1212/WNL.0b013e31823efca9.Google Scholar
19. Barenfanger, J, Lawhorn, J, Drake, C. Nonvalue of culturing cerebrospinal fluid for fungi. J Clin Microbiol. 2004;42(1):236-238. https://doi.org/10.1128/JCM.42.1.236-238.2004.Google Scholar
20. Rosenstein, NE, Perkins, BA, Stephens, DS, et al. Meningococcal disease. N Engl J Med. 2001;344(18):1378-1388. https://doi.org/10.1056/NEJM200105033441807.Google Scholar
21. World Health Organization. The Global Burden of Disease: 2004 Update. http://www.who.int/healthinfo/global_burden_disease/2004_report_update/en/. Published 2008. Accessed May 4, 2017.Google Scholar
22. Virginia Department of Health. Fungal meningitis attack rate in Virginia based on epidural steroid injection lot numbers. Richmond, VA: Virginia Department of Health; 2015.Google Scholar
23. US Census Bureau. Life Expectancy. Statistical Abstract of the United States: 2012. https://www.census.gov/library/publications/2011/compendia/statab/131ed.html. Published 2012. Accessed May 4, 2017.Google Scholar
24. Bell, BP, Khabbaz, RF. Responding to the outbreak of invasive fungal infections: the value of public health to Americans. JAMA. 2013;309(9):883-884. https://doi.org/10.1001/jama.2013.526.CrossRefGoogle Scholar
25. Corvese, K, Forlano, L, Gibson, L. A hybrid strategy for surveillance of individuals potentially exposed to contaminated methylprednisolone acetate--Virginia, 2012. J Public Health Manag Pract. 2013;19(4):289-293. https://doi.org/10.1097/PHH.0b013e318294e603.Google Scholar