Cost analysis of candidaemia in patients on the intensive care unit

Ref ID: 17764

Author:

S. Heimann*, O.A. Cornely, H. Wisplinghoff, M. Vehreschild,
B. Franke, J. Glossmann, J.-J. Vehreschild

Author address:

(Cologne, DE)

Full conference title:

22nd European Congress of Clinical Microbiology and Infectious Diseases

Abstract:

Objectives: Direct costs caused by candidemia in ICU patients are
currently unknown. We performed an analysis comparing costs
depending on the type of antifungal treatment.
Methods: Comprehensive data of patients from the University
Hospital of Cologne with at least one blood culture positive for
Candida spp. while staying on the ICU between 2005 and 2010 were
documented into a database provided by the Cologne Cohort of
Neutropenic Patients (CoCoNut). Analysis was split for patients treated
with new (i.e. echinocandins, liposomal amphotericin B, or
voriconazole) or conventional antifungals (i.e. amphotericin B
deoxycholate or fluconazole).
Results: Out of 120 patients identified, 41 received new and 55
conventional antifungals; 24 patients were excluded (19 died within
96 hours after positive blood culture, five were rated as contamination).
Both groups were well matched by age and baseline intubation status.
Mean durations of medical care per patient in the new and conventional
antifungal groups were as follows: ICU treatment 21.5 days (95% CI:
15.2-27.9 days) vs. 13.7 days (95% CI: 9.4-17.9 days), general ward
treatment 10.12 days (95% CI: 5.3-15 days) vs. 9.2 days (95% CI: 5.3-
13.2 days), mechanical ventilation 474 hour (95% CI: 323-624 hour)
vs. 304 hour (95% CI: 197-410 hour), and dialysis: 31.5 hour (95% CI:
9.6-53.3 hour) vs. 39.7 hour (95% CI: 16.0-63.4 hour). Mean direct
costs per patient in the new and the conventional antifungal groups were
as follows: ICU treatment 27 291 (95% CI: 19 282-35 300 ) vs. 17 188
(95% CI: 11 783-22 593 , p = 0.032), antifungal treatment 4916 (95%
CI: 3595-6238 ) vs. 1812 (95% CI: 866-2758, p < 0.001), total direct costs 44 451 (95% CI: 33 157-55 745 ) vs. 27 844 (95% CI: 19 968- 35 720 , p = 0.014). Conclusion: Our cost-of-illness analysis shows the high treatment costs of patients with candidemia. Actual antifungal drug costs play a minor role compared to the substantial costs of clinical and supportive care. In our analysis, treatment with new antifungals was associated with higher costs and a longer period of hospitalisation. However, as new antifungals are often considered less toxic, less interacting, better tolerated, and/or more effective, there may have been a treatment bias towards sicker patients more likely receiving treatment with these drugs

Abstract Number: NULL

Conference Year: 2012

Link to conference website: NULL

New link: NULL

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