Clinical and Financial Impact of Adoption of Micafungin as the Preferred Echinocandin in a University Teaching Hospital

JAMES S. LEWIS, PhD1, JAMES H. JORGENSEN, PhD2, JAN E. PATTERSON, MD2

Author address: 

1University Health System, San Antonio, TX, 2UT Health Sci Ctr, San Antonio, TX.

Abstract: 

Background: Antifungal acquisition represents a significant expenditure for healthcare systems. With the increasing number of echinocandins available for serious fungal infections, acquisition cost, when efficacy is equivalent, will become significant in determining the preferred agent. We examined the financial impact of the addition of micafungin (MFG) to our formulary in 6/05 and the subsequent replacement of caspofungin (CFG) with MFG in 1/06. Dosing was 100 mg MFG daily for Candida spp. infections and 150 mg daily for possible/proven aspergillosis. Methods: All patients that received MFG through 5/1/06 were reviewed. Indication, dose, duration, toxicity, and outcome were collected. Financial impact was determined by comparing the acquisition cost of MFG to CFG. We were particularly interested to determine if higher doses of MFG might be employed since they have been reported in the literature. Results: 64 patients received 66 courses of MFG. 4 patients received MFG in combination with voriconazole for possible/proven invasive aspergillosis. 2 patients received presumptive therapy for persistent neutropenic fever. The remaining 58 patients were treated for suspected/proven invasive candidiasis. 28 of 58 were solid organ transplant patients in either the transplant ICU or transplant telemetry units. 14 of 58 were in the surgical or medical ICUs. 17 patients with proven candidemia received MFG 100 mg per day and 16 responded well. 1 patient had persistent candidemia due to a retained central catheter though this organism maintained an MFG MIC of 0.03 mcg/ml. Mean duration of MFG therapy = 9.1 days. Cost avoidance = (CFG $310/d MFG $184/d) X days of therapy. Cost avoidance per patient was $999. Total drug cost avoidance was $63,945. No adverse events were attributed to MFG. No dose escalation beyond 100 mg for Candida spp. occurred. Conclusions: Addition of MFG to the formulary and subsequent replacement of CFG resulted in good clinical outcomes and significant cost avoidance.
2006

abstract No: 

573

Full conference title: 

Infectious Diseases Society of America, 44th Annual Meeting
    • IDSA 44th