The individual health care costs of a severe case of valley fever can be devastating. But with thousands of cases of the fungal disease each year in California, what’s the cost to society? A new study makes an astounding estimate.
Between 2014 and 2017, reports of valley fever in California tripled to more than 7,000 cases, and the total has continued to rise ever since. While most who contract the disease will overcome it without presenting symptoms, the most severe cases, in which the infection disseminates beyond the lungs and into other organs, can require long-term treatment and lead to other health complications.
In light of the rare but costly complications of the disease, researchers asked: How much does valley fever cost the state of California? “The big overall number is about $700 million annually based on the number of cases that we saw in 2017,” says Dr. Michael Peterson, Associate Dean of the UCSF Fresno School of Medicine and a coauthor of the study published earlier this year in the International Journal of Environmental Research and Public Health. “I can't say it shocked me, but it was a sobering number.”
Peterson and his colleagues arrived at that total by modeling the life cycle of the disease, estimating the direct and indirect costs at varying stages, and predicting the likelihood of each patient reaching each stage. Estimated individual costs range from $22,000 for mild cases to over $1 million for disseminated disease. “It includes the cost of diagnosis, it includes lost work for the patients who can't work or miss school, diagnostic studies that you might do, cost of treatment,” he says. “All of those things are factored in.”
Those costs could be reduced, Peterson says, with cheaper diagnostic tools as well as earlier diagnosis. Valley fever is commonly misdiagnosed as pneumonia, which can waste the patient’s time and money on the wrong treatment regimen and potentially allow the disease to worsen.
Peterson also hopes this first-of-its-kind cost estimate will help put research investment into perspective. “If you're spending $700 million,” he asks, “how much money should you be putting back into research and development to try and decrease that cost?”
In 2018, Governor Jerry Brown’s administration pumped $8 million into disease research and outreach, much of which was split between the University of California system and the Valley Fever Institute at Kern Medical in Bakersfield. Many credit the investment with spurring on a host of new collaborative research initiatives, including projects to study genetic predisposition to the disease and the virulence of various fungal strains that grow in the environment.
As of late September 2019, state officials were reporting more than 6,000 cases of the disease—a higher total than was reported over the same time period during either of the previous two years. Kern County routinely reports a third of all California's cases.