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Antifungal prophylaxis/therapy (AP/AT) raises the cost of allogeneic haematopoietic cell transplantation (alloHCT). Its efficacy, different approaches for AP/AT, diagnostic measures and cost-effectiveness must still be evaluated. In 2010, we conducted a prospective study with 106 consecutive patients receiving an alloHCT analysing AP/AT, choice and costs of diagnostics applied including CT scans, galactomannan (Gal) and β-D-glucan (β-D) testing. Antifungal prophylaxis in 91 patients consisted of fluconazole (FLU) or L-AMB (AmBisome™ 1 or 3 mg/kg/day b.w.), and antifungal therapy had to be initiated in 38 % of the FLU/L-AMB-1-mg patients but in none with L-AMB 3 mg. Empirical AT consisted of L-AMB 1 mg/kg (n = 12) and preemptive AT of L-AMB 3 mg/kg (n = 17) and proved very efficacious with no further antifungal drug escalation in 89.6 %. Mean costs of diagnostic measures were 402 €/alloHCT; however, only 22 % of the CT scans, 4 % of β-D and 3 % of galactomannan testing were positive. We detected one proven, 17 probable and 14 possible fungal infections. Due to the German diagnosis-related group system with additional compensation, all our AP/AT strategies were adequately reimbursed. While clinical symptoms and CT scans are the most commonly used, inexpensive decision-making tools for starting AT, the expensive laboratory diagnostic procedures are ineffective; we have therefore discontinued regular GAL/β-D testing and changed our AP in patients at risk.

Economic assessment of damage caused by invasive alien species provides useful information to consider when determining whether management programs should be established, modified, or discontinued. We estimate the baseline economic damage from an invasive alien pathogen, Ceratocystis fagacearum, a fungus that causes oak wilt, which is a significant disease of oaks (Quercus spp.) in the central United States. We focus on Anoka County, Minnesota, a 1,156 km(2) mostly urban county in the Minneapolis-Saint Paul metropolitan region. We develop a landscape-level model of oak wilt spread that accounts for underground and overland pathogen transmission. We predict the economic damage of tree mortality from oak wilt spread in the absence of management during the period 2007-2016. Our metric of economic damage is removal cost, which is one component of the total economic loss from tree mortality. We estimate that Anoka County has 5.92 million oak trees and 885 active oak wilt pockets covering 5.47 km(2) in 2007. The likelihood that landowners remove infected oaks varies by land use and ranges from 86% on developed land to 57% on forest land. Over the next decade, depending on the rates of oak wilt pocket establishment and expansion, 76-266 thousand trees will be infected with discounted removal cost of $18-60 million. Although our predictions of removal costs are substantial, they are lower bounds on the total economic loss from tree mortality because we do not estimate economic losses from reduced services and increased hazards. Our predictions suggest that there are significant economic benefits, in terms of damage reduction, from preventing new pocket establishment or slowing the radial growth of existing pockets.