Drug costs and utilization after implementation of a posaconazole prophylaxis protocol in adults with acute myelogenous leukemia.
OBJECTIVE
Drug costs and utilization after implementation of a posaconazole prophylaxis protocol in adults with acute myelogenous leukemia (AML) were studied.


METHODS
Adult patients who initiated induction or reinduction chemotherapy for the treatment of AML between December 1, 2006, and March 31, 2008, at a tertiary care hospital were included in this retrospective cohort study. Patients were divided into two groups: preprotocol (treated before June 1, 2007) and postprotocol (treated on or after June 1, 2007). Medical charts, including pharmacy and laboratory data, were reviewed for all patients. Outcomes measured included antifungal and antibacterial drug costs and utilization and total pharmacy costs.


RESULTS
A total of 66 patients were evaluated (33 in each group). Baseline characteristics, except patient age, were similar between groups. Each group incurred similar costs and utilized resources for similar periods of time as evidenced by similar lengths of stay, duration of neutropenia, and mortality. Antibacterial costs, total pharmacy costs, and other utilization outcomes were also similar between the two groups. Alterations to antifungal management strategy occurred more often in the postprotocol group (33% versus 58%, p = 0.048).


CONCLUSIONS
Implementation of a posaconazole protocol did not significantly alter antifungal or antibacterial drug costs or utilization or total pharmacy costs. Prophylactic posaconazole was frequently changed to alternative antifungal therapy due to an adverse drug event, perceived lack of efficacy, avoidance of a drug interaction, or inability to tolerate oral intake.
Nemerovski
Carrie W
CW
University of Michigan Hospitals and Health Centers (UMHHC), Ann Arbor, MI, USA. cnemerovski@wayne.edu
Mackler
Emily R
ER
DePestel
Daryl D
DD
Collins
Curtis D
CD
Welch
Kathleen S
KS
Stevenson
James G
JG
D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000191:economics; D000935:Antifungal Agents / Q000008:administration & dosage* / Q000009:adverse effects / Q000191:economics*; D000970:Antineoplastic Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000191:economics; D016527:Drug Costs; D004363:Drug Utilization / Q000191:economics; D005260:Female; D006801:Humans; D015470:Leukemia, Myeloid, Acute / Q000188:drug therapy* / Q000191:economics / Q000382:microbiology; D008297:Male; D008875:Middle Aged; D009181:Mycoses / Q000139:chemically induced / Q000191:economics / Q000517:prevention & control*; D010607:Pharmacy Service, Hospital / Q000191:economics; D012189:Retrospective Studies; D014230:Triazoles / Q000008:administration & dosage* / Q000009:adverse effects / Q000191:economics
D000900:Anti-Bacterial Agents; D000935:Antifungal Agents; D000970:Antineoplastic Agents; D014230:Triazoles; C101425:posaconazole