Due to economic concerns at a large teaching hospital, ABLC may only be used if a patient fails other antifungal therapy, has a change in serum creatinine of 1.5mg/dl on amphotericin B or has a baseline creatinine >= 2.5mg/dl. A case matched controlled study matching ABLC patients to amphotericin B patients was performed to determine if the high cost of ABLC can be justified. All adult patients (n=30) who received ABLC for >= 4 days, for documented or suspected aspergillosis or candida infection during 1996-1997, were identified through hospital records . Twenty-eight cases (ABLC) were matched to controls (amphotericinB) for DRG, ICD-9 codes, and age +/- 10 years. Data was not available for 2 cases. The clinical and economic data collected included length of antifungal therapy, length of stay, baseline serum creatinine, change in serum creatinine during therapy, patient outcome, and hospital charges. Length of therapy for ABLC vs amphotericin B was 14.3 and 14.9 days, length of stay 45.4 and 42.2 days, baseline serum creatinine 2.95mg/dl and 1.7 mg/dl (p=0.01), change in serum creatinine -0.5mg/dl and 0.7mg/dl, and patient outcomes as measured by mortality 43% and 25% (p=0.16) respectively. The economic analysis, comparing ABLC and amphotericin B, reflected mean hospital charges of 152,140 dollars vs 113,448 dollars (p=0.27) and pharmacy charges of 55,904 dollars vs 38,082 dollars (p=0.23), respectively. Results show there was no significant difference between cases and controls, for any of the measured clinical or economic variables, except baseline serum creatinine, which was higher for the ABLC group. This was expected since elevated serum creatinine was a criteria for using ABLC. The significant difference in baseline serum creatinine between ABLC and amphotericin B showed that our criteria for using ABLC were followed. The lack of significant economic difference demonstrates ABLC was cost justified from the hospitals perspective. The trend towards a decrease in serum creatinine in the ABLC group suggests future research should focus on the economics of using ABLC earlier to determine if mortality rate improves.
Full conference title:
38th Interscience Conference on Antimicrobial Agents and Chemotherapy
- ICAAC 38th