title: Cost savings with implementation of PNA FISH testing for identification of Candida albicans in blood cultures.
abstract: Antifungal expenditures are substantial for many hospitals. Using caspofungin for the treatment of candidemia accounts for a sizable proportion of the costs. A cost minimization study that used a decision analytic model was done to compare in-hospital diagnosis and treatment costs using the Candida albicans peptide nucleic acid fluorescence in situ hybridization (PNA FISH) test versus the C. albicans screen test for differentiating C. albicans from non-albicans Candida species bloodstream infections. Assuming physician notification of yeast identity concurrent with blood culture positivity, potential savings resulting from use of the C. albicans PNA FISH test compared with the C. albicans screen test averaged $1837 per patient treated, although laboratory costs for doing the C. albicans PNA FISH test ($82.72) exceeded those for the C. albicans screen test ($2.83). Savings were realized through a decrease in antifungal drug costs, particularly caspofungin. Incorporating the C. albicans PNA FISH test as part of the initial identification algorithm for yeasts recovered from blood can result in substantial savings for hospitals.
authors.affiliation: Division of Infectious Diseases and International Health, Department of Medicine, Duke University Medical Center, Box 3035, Durham, NC 27710, USA. alexa011@mc.duke.edu
authors.forename: Barbara D
authors.initials: BD
authors.lastname: Alexander
authors.forename: Elizabeth Dodds
authors.initials: ED
authors.lastname: Ashley
authors.forename: L Barth
authors.initials: LB
authors.lastname: Reller
authors.forename: Shelby D
authors.initials: SD
authors.lastname: Reed
mesh_terms: D000935:Antifungal Agents / Q000191:economics / Q000627:therapeutic use; D002176:Candida albicans / Q000235:genetics / Q000302:isolation & purification*; D002177:Candidiasis / Q000175:diagnosis* / Q000188:drug therapy / Q000191:economics*; D000077336:Caspofungin; D017046:Cost Savings; D054714:Echinocandins; D016469:Fungemia / Q000175:diagnosis* / Q000188:drug therapy / Q000191:economics*; D006801:Humans; D017404:In Situ Hybridization, Fluorescence / Q000191:economics* / Q000379:methods; D055666:Lipopeptides; D020135:Peptide Nucleic Acids; D010456:Peptides, Cyclic / Q000191:economics / Q000627:therapeutic use
chemical_list: D000935:Antifungal Agents; D054714:Echinocandins; D055666:Lipopeptides; D020135:Peptide Nucleic Acids; D010456:Peptides, Cyclic; D000077336:Caspofungin