Matthew S. Simon

Cost-effectiveness of blood donor screening for Babesia microti in endemic regions of the United States.

Babesia microti is the leading reported cause of red blood cell (RBC) transfusion‐transmitted infection in the United States. Donor screening assays are in development.

Management of End-Stage Ankle Arthritis: Cost-Utility Analysis Using Direct and Indirect Costs.

BACKGROUND Total ankle replacement and ankle fusion are costly but clinically effective treatments for ankle arthritis. Prior cost-effectiveness analyses for the management of ankle arthritis have been limited by a lack of consideration of indirect costs and nonoperative management. The purpose of this study was to compare the cost-effectiveness of operative and nonoperative treatments for ankle arthritis with inclusion of direct and indirect costs in the analysis. METHODS Markov model analysis was conducted from a health-systems perspective with use of direct costs and from a societal perspective with use of direct and indirect costs. Costs were derived from the 2012 Nationwide Inpatient Sample (NIS) and expressed in 2013 U.S. dollars; effectiveness was expressed in quality-adjusted life years (QALYs). Model transition probabilities were derived from the available literature. The principal outcome measure was the incremental cost-effectiveness ratio (ICER). RESULTS In the direct-cost analysis for the base case, total ankle replacement was associated with an ICER of

Endocarditis caused by rhodotorula infection

14,500/QALY compared with nonoperative management. When indirect costs were included, total ankle replacement was both more effective and resulted in

Cost-Effectiveness of Fidaxomicin for Clostridium difficile Treatment

5900 and

Emerging Infections and Blood Safety in the 21st Century

800 in lifetime cost savings compared with the lifetime costs following nonoperative management and ankle fusion, respectively. At a

Clinical and Molecular Evidence of Atovaquone and Azithromycin Resistance in Relapsed Babesia microti Infection Associated With Rituximab and Chronic Lymphocytic Leukemia

100,000/QALY threshold, surgical management of ankle arthritis was preferred for patients younger than ninety-six years and total ankle replacement was increasingly more cost-effective in younger patients. Total ankle replacement, ankle fusion, and nonoperative management were the preferred strategy in 83%, 12%, and 5% of the analyses, respectively; however, our model was sensitive to patient age, the direct costs of total ankle replacement, the failure rate of total ankle replacement, and the probability of arthritis after ankle fusion. CONCLUSIONS Compared with nonoperative treatment for the management of end-stage ankle arthritis, total ankle replacement is preferred over ankle fusion; total ankle replacement is cost-saving when indirect costs are considered and demonstrates increasing cost-effectiveness in younger patients. As indications for and utilization of total ankle replacement increase, continued research is needed to define appropriate subgroups of patients who would likely derive the greatest clinical benefit from that procedure. LEVEL OF EVIDENCE Economic and decision analysis Level II. See Instructions for Authors for a complete description of levels of evidence.

Cost-Effectiveness of Meningococcal Vaccination Among Men Who Have Sex With Men in New York City.

ABSTRACT Rhodotorula is an emerging opportunistic fungal pathogen that is rarely reported to cause endocarditis. We describe a case involving a patient who developed endocarditis due to Rhodotorula mucilaginosa and Staphylococcus epidermidis, proven by culture and histopathology. The case illustrates the unique diagnostic and therapeutic challenges relevant to Rhodotorula spp.

Cost-Effectiveness Analysis of Probiotic Use to Prevent Clostridium difficile Infection in Hospitalized Adults Receiving Antibiotics

TO THE EDITOR—Bartsch and colleagues recently evaluated the cost-effectiveness of fidaxomicin treatment for Clostridium difficile infection and should be commended for addressing this important question [1]. In light of a recent Centers for Disease Control and Prevention report estimating 250 000 C. difficile infections per year resulting in 14 000 deaths and excess medical costs of

Babesia microti: from Mice to Ticks to an Increasing Number of Highly Susceptible Humans

1 billion annually [2], understanding the economic value of C. difficile prevention and treatment strategies has major public health implications in the United States. The authors compared a strategy of NAP1/BI/027 strain-targeted fidaxomicin treatment compared to metronidazole or vancomycin treatment depending on disease severity and found an unfavorable cost-effectiveness ratio of

Impact of Hospitalist-Led Interdisciplinary Antimicrobial Stewardship Interventions at an Academic Medical Center

46 million per quality-adjusted life-year (QALY) for the fidaxomicin strain-targeted approach. The authors concluded that fidaxomicin is not cost-effective at current pricing and national prevalence estimates of C. difficile strain type NAP1/BI/027. Another recently published cost-effectiveness analysis on this topic had different findings: Stranges and colleagues found significantly more favorable cost-effectiveness ratios of