Effect of prophylaxis on fungal infection and costs for high-risk liver transplant recipients.
We sought to determine whether the prophylactic use of amphotericin B products (conventional amphotericin B and liposomal amphotericin B) reduces the incidence of fungal infections in high-risk liver transplant recipients, and if so, whether this lowers the cost of care. The study sample comprised 232 adult orthotopic liver transplants performed from 1994 to 2005 at a single center for patients classified as being at high risk for fungal infections. High-risk patients who received transplants with a prophylaxis regimen of amphotericin B (n=58 transplants) were compared with high-risk patients who received no prophylaxis (n=174 transplants). Fungal infections occurred in 3 transplants (5.17%) of those who received amphotericin B and 28 transplants (16.09%) in those without prophylaxis (P=0.0432). Regression models were used to analyze fungal infection and costs for the 232 high-risk transplants. Failure to offer prophylaxis conferred a 4-fold greater risk of fungal infection (P=0.046) compared with those who received amphotericin B. A fungal infection in a high-risk recipient increased mean costs by 46.48%. The indirect effect of prophylaxis (operating through infection reduction) is estimated to reduce overall costs in high-risk patients by 8.73%.
Department of Surgery, Shands Hospital Transplant Center, University of Florida College of Medicine, Shands Transplant Center, Gainesville, FL 32610, USA. Reed@Surgery.ufl.edu
Alan
A
Reed
Jill Boylston
JB
Herndon
Nail
N
Ersoz
Takahisa
T
Fujikawa
Denise
D
Schain
Paul
P
Lipori
Alan
A
Hemming
Qin
Q
Li
Elizabeth
E
Shenkman
Bruce
B
Vogel
D000328:Adult; D000666:Amphotericin B / Q000191:economics / Q000627:therapeutic use*; D000935:Antifungal Agents / Q000191:economics / Q000627:therapeutic use*; D003362:Cost-Benefit Analysis; D016527:Drug Costs; D005260:Female; D006801:Humans; D016031:Liver Transplantation / Q000009:adverse effects* / Q000191:economics; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D018803:Models, Economic; D009181:Mycoses / Q000191:economics / Q000209:etiology / Q000517:prevention & control*; D016017:Odds Ratio; D012189:Retrospective Studies; D018570:Risk Assessment; D016896:Treatment Outcome
D000935:Antifungal Agents; C068538:liposomal amphotericin B; D000666:Amphotericin B