Histoplasmosis-related healthcare use, diagnosis, and treatment in a commercially insured population, United States

Details

• Alternative Title:
  Clin Infect Dis
• Personal Author:
  Benedict, Kaitlin ; Beer, Karlyn D. ; Jackson, Brendan R.
• Description:
  Background:
  
  Infections with Histoplasma can range from asymptomatic to life-threatening acute pulmonary or disseminated disease. Histoplasmosis can be challenging to diagnose and is widely under-recognized. We analyzed insurance claims data to better characterize histoplasmosis testing and treatment practices and its burden on patients.
  
  Methods:
  
  We used the IBM® MarketScan® Research Databases to identify patients with histoplasmosis (International Classification of Diseases, Ninth Revision, Clinical Modification [ICD-9-CM] codes 115.00–115.99) during 2012–2014. We analyzed claims in the 3 months before to the 1 year after diagnosis and examined differences between probable (hospitalized or >1 outpatient visit) and suspect (1 outpatient visit) patients.
  
  Results:
  
  Among 1,935 patients (943 probable, 922 suspect), 54% had codes for symptoms or findings consistent with histoplasmosis and 35% had ≥2 healthcare visits in the 3 months before diagnosis. Overall, 646 (33%) had any fungal-specific laboratory test: histoplasmosis antibody test (n= 349, 18%), Histoplasma antigen test (n=349, 18%), fungal smear (n=294, 15%), or fungal culture (n=223, 12%); 464 (24%) had a biopsy. Forty-nine percent of probable patients and 10% of suspect patients were prescribed antifungal medication in the outpatient setting. Total, 19% were hospitalized. Patients’ last histoplasmosis-associated healthcare visits occurred a median of 6 months after diagnosis.
  
  Conclusions:
  
  Some histoplasmosis patients experienced severe disease, apparent diagnostic delays, and prolonged illness, whereas other patients lacked symptoms and were likely diagnosed incidentally (e.g., via biopsy). Low rates of histoplasmosis-specific testing also suggest incidental diagnoses and low provider suspicion, highlighting the need for improved awareness about this disease.
  
  
• Subjects:
  Antifungal Agents Antifungal Treatment Article Delivery Of Health Care Diagnosis Histoplasma Histoplasmosis Hospitalization Humans Lung Diseases, Fungal Outpatients United States

  More +
• Source:
  Clin Infect Dis. 70(6):1003-1010
• Pubmed ID:
  31037290
• Pubmed Central ID:
  PMC6821563
• Document Type:
  Journal Article
• Funding:
  CC999999/ImCDC/Intramural CDC HHS/United States
• Volume:
  70
• Issue:
  6
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha256:de1182c6197d3843815105e9a0222a4b869efd016e6bef225ea21b12bec06112
• Download URL:
  https://stacks.cdc.gov/view/cdc/83043/cdc_83043_DS1.pdf
• File Type:
  [PDF - 676.61 KB ]