Delays in Coccidioidomycosis Diagnosis and Associated Healthcare Utilization, Tucson, Arizona, USA

Abstract

Tucson, Arizona, USA, is a highly coccidioidomycosis-endemic area. We conducted a retrospective review of 815 patients in Tucson over 2.7 years. Of 276 patients with coccidioidomycosis, 246 had a delay in diagnosis; median delay was 23 days. Diagnosis delay was associated with coccidioidomycosis-related costs totaling $589,053 and included extensive antibacterial drug use.

Keywords: Arizona; Tucson; Valley fever; antimicrobial drugs; coccidioidomycosis; delay in diagnosis; fungi; healthcare cost.

Figure 1

Cumulative distribution for time to diagnosis of coccidioidomycosis for 4 disease categories among patients in Tucson, Arizona, USA, January 1, 2015–September 18, 2017. Time points related to patients with very extended delay period (909 days in acute pulmonary disease, 928 days in pulmonary nodule, and 3,315 days in disseminated disease) are not shown in the graph. Timeline truncated for readability.

Figure 2

Coccidioidomycosis costs by disease category for 264 case-patients in Tucson, Arizona, USA, January 1, 2015–September 18, 2017. Costs are shown in 2 columns for each category: the left column for diagnosis at initial presentation and the right column for delayed diagnosis. Each symbol represents 1 case. Numbers in parentheses indicate the number of cases in each category. Cost axis truncated for readability.