title: Economic analysis of inadequate fluconazole therapy in non-neutropenic patients with candidaemia: a multi-institutional study.
abstract: Mortality significantly increases in patients with candidaemia who receive inappropriate fluconazole therapy. The goals of this study were to compare hospital length of stay and costs for non-neutropenic patients with candidaemia treated with fluconazole based on the empirical dose and time until initiation of therapy. A retrospective cohort study was conducted of patients with candidaemia who were prescribed fluconazole at the onset of candidaemia or later. Hospital-related costs were compared based on time to initiation of fluconazole therapy and empirical fluconazole dose. A total of 192 non-neutropenic patients (55% male; mean age+/-standard deviation, 56+/-17 years) were identified. Isolated Candida species included C. albicans (59%), C. glabrata (15%), C. parapsilosis (11%), C. tropicalis (6%), C. krusei (3%) or other Candida spp. (6%). Time to initiation of fluconazole was Day 0 (35.4%), Day 1 (14.1%), Day 2 (26.6%) or Day >or=3 (23.9%). Thirty-two patients (17%) received a dose of fluconazole >or=6 mg/kg on Day 0. Total costs were lowest for patients started on fluconazole on the culture day with adequate doses ($35,459+/-25,988) compared with all other patients ($52,158+/-53,492) (P=0.0088). After controlling for covariates, each 1-day delay in fluconazole therapy was associated with increased total hospital costs of $6392+/-3000 (P=0.0344), and an adequate fluconazole dose was associated with decreased total hospital costs of $18,744+/-7173 (P=0.0097). A delay or an inadequate dose or fluconazole in patients with candidaemia was associated with increased hospital costs. Improved methods to diagnose patients with candidaemia quickly are needed.
authors.affiliation: Texas Medical Center, University of Houston, 1441 Moursund Street, Houston, TX 77030, USA. kgarey@uh.edu
authors.forename: Kevin W
authors.initials: KW
authors.lastname: Garey
authors.forename: Robin S
authors.initials: RS
authors.lastname: Turpin
authors.forename: David T
authors.initials: DT
authors.lastname: Bearden
authors.forename: Manjunath P
authors.initials: MP
authors.lastname: Pai
authors.forename: Katie J
authors.initials: KJ
authors.lastname: Suda
mesh_terms: D000368:Aged; D000935:Antifungal Agents / Q000191:economics* / Q000627:therapeutic use*; D002177:Candidiasis / Q000188:drug therapy* / Q000191:economics* / Q000382:microbiology; D003365:Costs and Cost Analysis; D005260:Female; D015725:Fluconazole / Q000191:economics* / Q000627:therapeutic use*; D017052:Hospital Mortality; D006760:Hospitalization / Q000191:economics; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D000935:Antifungal Agents; D015725:Fluconazole