Background/Purpose: Bacterial and fungal infections (e.g., tuberculosis, histoplasmosis) have been associated with the use of TNF-α inhibitors (TNFI). Although screening for specific infections prior to initiating TNFI has been recommended, the costs associated with screenings and treatment of these infections has not been well described in the literature. Thus, the study aim was to describe the costs associated with screenings for and the treatment of targeted fungal or mycobacterial infections in patients taking TNFI.

Methods: A case-control study (N = 436) was conducted using deidentified patient health claims information from a dataset representing a commercially-insured, U.S. population of 15 million patients annually (1/1/2007-12/31/2009). To begin, all patients who obtained a TNFI for any indication were extracted from the dataset which resulted in 25,949 unique patients.  These patients were then followed forward in time and defined as a case if they received medical care (inpatient or outpatient) for one (or more) targeted fungal or mycobacterial infections  (i.e., tuberculosis, histoplasmosis, unspecified mycosis, coccidioidomyocosis, cryptococcal) and 124 unique patients were identified. Fifteen of these patients had cancer and were excluded from the analyses; thus, 109 patients were defined as cases. Controls were randomly selected to frequency match cases on age and length of follow-up in a 3:1 ratio. Descriptive statistics were used to summarize standardized costs of screening and medical treatments attributed to targeted infections.

Results: Of the 436 patients in our sample the median cost for screening was $23.05 (Interquartile Ranges: Q1 = $10.20, Q3 = $46.73) for the total sample; $20.40 (Q1 = $10.20, Q3 = 46.73) for controls and $32.52 (Q1 = $10.2, Q3 = $46.73) for cases. See Table 1 for the cost per screening procedure. The median cost of infection treatment was $100.97 (Q1 = $45.12, Q3 = $276.56). See Table 2 for the cost per infection.

Conclusion: Although few patients in this study were diagnosed with a targeted infection (0.48%), from a cost perspective, the high cost of these infections relative to the low cost of the more frequently used screenings likely warrants their continued use in clinical practice.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/infection-and-screening-costs-related-to-tumor-necrosis-factor-alpha-inhibitor-use/