Impact of a Caspofungin (CAS) Restriction Policy on Appropriateness of Use and the Financial Implications in a Large Tertiary Hospital.


Author address: 

UCSF Med. Ctr., San Francisco, CA.


Background: CAS has been increasingly utilized as empiric treatment for candidiasis, aspergillosis and invasive fungal infections. UCSF Medical Center spent over $750,000 in 2005 on CAS. At the Medical Center, empiric CAS use requires approval by the Infectious Diseases service. No studies have examined the appropriateness of CAS use in a tertiary care hospital and the economic impact of inappropriate use. The objective of this study was to evaluate appropriateness of CAS use >72 hours duration per criteria. Methods: Patients hospitalized in 2005 who received CAS for >72 hours were retrospectively identified and reviewed. Each CAS course (duration of use >72 hours) was categorized as ’appropriate’, ’inappropriate’ or ’questionable’. A course was considered ’appropriate’ based on the following criteria: clinical microbiology data, radiography, intolerance to other antifungal agents, drug-drug interactions and breakthrough fungal infection. The computerized medical record was used to identify patient demographics, clinical microbiology, radiological information and histological data . Cost data was compiled. Results: 138 courses of CAS were identified in 123 unique hospitalizations. CAS was used appropriately in 119 (86%) of these cases. Of the remaining 19 (14%) cases, 8 (6%) were inappropriate and 11 (8%) were considered questionable uses. Of appropriate courses, 67 (56%) had microbiological confirmation (including non-albicans Candida spp., Aspergillus spp. and other fungi/yeast), 31(26%) had radiographic evidence and 30 (25%) were due to intolerance or drug-drug interactions. Inappropriate or questionable courses of CAS totaled $20,000 in 2005. Conclusions: Results indicate that CAS is being utilized appropriately in the majority of patients. However, continued improvement can take place, particularly with monitoring duration of therapy and reassessing appropriateness after 72 hours in patients receiving empiric courses.

abstract No: 


Full conference title: 

46th Interscience Conference on Antimicrobial Agents and Chemotherapy
    • ICAAC 46th