Promila Pagadala

Prevalence, healthcare resource utilization and overall burden of fungal meningitis in the United States

Purpose. Previous epidemiological and cost studies of fungal meningitis have largely focused on single pathogens, leading to a poor understanding of the disease in general. We studied the largest and most diverse group of fungal meningitis patients to date, over the longest follow‐up period, to examine the broad impact on resource utilization within the United States. Methodology. The Truven Health Analytics MarketScan database was used to identify patients with a fungal meningitis diagnosis in the United States between 2000 and 2012. Patients with a primary diagnosis of cryptococcal, Coccidioides, Histoplasma, or Candida meningitis were included in the analysis. Data concerning healthcare resource utilization, prevalence and length of stay were collected for up to 5 years following the original diagnosis. Results. Cryptococcal meningitis was the most prevalent type of fungal meningitis (70.1 % of cases over the duration of the study), followed by coccidioidomycosis (16.4 %), histoplasmosis (6.0 %) and candidiasis (7.6 %). Cryptococcal meningitis and candidiasis patients accrued the largest average charges (

Drivers and Risk Factors of Unplanned 30-Day Readmission Following Spinal Cord Stimulator Implantation

103 236 and

Specialty-Based Variations in Spinal Cord Stimulation Success Rates for Treatment of Chronic Pain

103 803, respectively) and spent the most time in the hospital on average (70.6 and 79 days). Coccidioidomycosis and histoplasmosis patients also accrued substantial charges and time in the hospital (

Explantation Rates and Healthcare Resource Utilization in Spinal Cord Stimulation

82 439, 48.1 days;

Novel Treatment of Cryptococcal Meningitis via Neurapheresis Therapy

78 609, 49.8 days, respectively). Conclusion. Our study characterizes the largest longitudinal cohort of fungal meningitis in the United States. Importantly, the health economic impact and long‐term morbidity from these infections are quantified and reviewed. The healthcare resource utilization of fungal meningitis patients in the United States is substantial.

Down the Rabbit Hole: Specialty Influence on SCS Outcomes: LETTER TO THE EDITOR

Unplanned 30‐day readmission rates contribute significantly to growing national healthcare expenditures. Drivers of unplanned 30‐day readmission after spinal cord stimulator (SCS) implantation are relatively unknown. The aim of this study was to determine drivers of 30‐day unplanned readmission following SCS implantation.

Prevalence and Cost Analysis of Complex Regional Pain Syndrome (CRPS): A Role for Neuromodulation

Spinal cord stimulation (SCS) has emerged as an appropriate modality of treatment for intractable chronic pain. The present study examines variations in SCS trial‐to‐permanent conversion rates based on provider types performing the procedure.

Prevalence and Cost Analysis of Chronic Pain After Hernia Repair: A Potential Alternative Approach With Neurostimulation: PAIN AFTER HERNIA REPAIR: A POTENTIAL WITH NEUROSTIMULATION

Certain patients ultimately undergo explantation of their spinal cord stimulation (SCS) devices. Understanding the predictors and rates of SCS explantation has important implications for healthcare resource utilization (HCRU) and pain management. The present study identifies explant predictors and discerns differences in HCRU for at‐risk populations.

Impact of Insurance Provider on Overall Costs in Failed Back Surgery Syndrome: A Cost Study of 122,827 Patients: IMPACT OF INSURANCE DISPARITIES ON OVERALL COST FOR FBSS

Cryptococcal meningitis (CM) has emerged as the most common life-threatening fungal meningitis worldwide. Current management involves a sequential, longitudinal regimen of antifungals; despite a significant improvement in survival compared with uniform mortality without treatment, this drug paradigm has not led to a consistent cure. Neurapheresis therapy, extracorporeal filtration of yeasts from cerebrospinal fluid (CSF) in infected hosts, is presented here as a novel, one-time therapy for CM. In vitro filtration of CSF through this platform yielded a 5-log reduction in concentration of the yeast and a 1-log reduction in its polysaccharide antigen over 24 hours. Additionally, an analogous closed-loop system achieved 97% clearance of yeasts from the subarachnoid space in a rabbit model over 4-6 hours. This is the first publication demonstrating the direct ability to rapidly clear, both in vitro and in vivo, the otherwise slowly removed fungal pathogen that directly contributes to the morbidity and mortality seen in CM.

A Novel Therapeutic Approach for Cryptococcal Meningitis

We were very interested to read the letter “Through the Looking Glass” by Boortz-Marx and colleagues in response to our original manuscript, “Specialty-Based Variations in Spinal Cord Stimulation Success Rates for Treatment of Chronic Pain” (1). We are pleased that our work has generated interest by expert investigators in the neuromodulation community. Our intent was not to step through Lewis Carroll’s mirror into Alice in Wonderland’s strange and mysterious world. We are not going down the rabbit hole of pitting one or more specialties that offer neuromodulation approaches against one another. We also care deeply about the field of neuromodulation and want to ensure that we are not simply going “Somewhere,” but in a direction that allows sustainability and expansion of the field for the benefit of patients everywhere. Neuromodulation is a growing field, with an increasing number of specialties participating, offering novel approaches for previously untreatable and medically refractory conditions. The goal of our manuscript was to shed light on the need to better standardize education and training across multiple specialties that choose to incorporate neuromodulation approaches into their practices.