The high burden of hospitalizations for primary EBV infection: a 6-year prospective survey in a French hospital.

Primary Epstein-Barr virus infection (PEI) is acquired increasingly later in life in developed countries, involving a growing number of adults. No studies have examined the effect of age on PEI. We conducted a prospective, single-centre, noninterventional survey to assess the clinical and economic effects of PEI care according to age. We included all serology-confirmed cases observed in all departments of a large regional hospital. Clinical and biologic data, therapeutics and costs of care were examined. Over a 6-year period, we included 292 subjects (148 children and 144 adults) with a median age of 15.4 years (range 9 months to 79 years). Adults were hospitalized more often (83% vs. 60%) and for longer periods of time (median 4 days vs. 2 days) than children (p ≤ 0.0001 for both). Two adults required a secondary transfer into the intensive care unit, although no children did. Typically, adults showed higher levels of activated lymphocytes and liver abnormalities. They also required the use of systemic corticosteroids more often (45% vs. 23%, p < 0.0001) and for longer periods of time (median 7 days vs. 3 days, p 0.02) than children. Overall, the costs were significantly higher for adults than for children (median, €1940 vs. €1130, p < 0.0001), mainly because of the frequency and duration of hospitalizations. Age increases the immune response and clinical severity of PEI, resulting in substantial additional costs for the community. Better recognition of the disease in adults could shorten the average length of hospital stay.

Pre-emptive virology screening in the pediatric hematopoietic stem cell transplant population: a cost effectiveness analysis.

BACKGROUND AND OBJECTIVES: Pediatric patients undergoing hematopoietic stem cell transplant (HSCT) are at a uniquely high risk of cytomegalovirus (CMV) and Epstein-Barr virus (EBV) infections. The pre-emptive treatment model whereby asymptomatic post-transplant patients are routinely screened with treatment initiated if found viremic has recently been shown to be superior in terms of patient mortality when compared to deferring laboratory assessment and treatment until symptoms emerge. This study analyzes the cost-effectiveness of the pre-emptive therapy model in patient care dollars per quality-adjusted life years (QALY). PATIENTS AND METHODS: Utilization and outcome data were compiled as a retrospective cohort study of 96 pediatric patients receiving HSCT at University of California Los Angeles Pediatric Hematology/Oncology Department between the years 2006 and 2010. Two-decision tree models were constructed for each the pre-emptive model and the deferred model wherein costs and probability assumptions were based on either previously published literature or calculated from this study cohort. RESULTS: The pre-emptive model resulted in a five-year survival of 71%, during which time 4% of patients were found to be EBV viremic, while 33% were found to be CMV viremic. The average actual cost of EBV/CMV virology screening per patient in the cohort following the pre-emptive model was $9699 while the expected cost following the deferred model was $19,284. This results in an incremental cost effectiveness ratio illustrating pre-emptive model cost-savings of $2367/QALY. CONCLUSION: These results support the financial viability and prudence of scheduled screening for subclinical viremia for achieving optimal outcomes in a cost-effective manner in the pediatric HSCT population.

Clinical features and costs of care for hospitalized adults with primary Epstein-Barr virus infection.

PURPOSE: To study the clinical and laboratory features of primary infection with the Epstein-Barr virus in adults who required hospitalization and to assess the difficulty in its diagnosis, the use of diagnostic procedures, and the associated costs of care. PATIENTS AND METHODS: We retrospectively identified all adult patients who were diagnosed with primary Epstein-Barr virus infection in our region between 1988 and 1997 using strict serologic criteria. The added costs of unnecessary diagnostic tests and treatment were estimated. RESULTS: The analysis included 47 patients (60% men) with a mean (+/-SD) age of 30 +/- 14 years. The prime cause of admission was fever (83%). Compared with patients 35 years of age and older, those younger than 35 years were more likely to have pharyngitis (45% vs 10%) and lymphadenopathy (66% vs 17%). Younger patients also had a greater mean atypical lymphocyte count (17% +/- 14% vs 8% +/- 6%) and more abnormal hepatic enzyme levels. Inpatient work-ups resulted in 309 days of hospitalization, many diagnostic tests, and unnecessary empiric treatments (total 203 days of antibiotic therapy). Overall, unnecessary diagnostic procedures and medical treatments contributed an average of approximately $12,000 in health-care costs per patient. CONCLUSIONS: Testing for primary Epstein-Barr virus infection should be a routine step in the investigation of fever in adults of all ages. A higher index of suspicion might prevent unnecessary, sometimes hazardous inpatient work-ups from being performed, thereby reducing health-care expenses.