title: Antifungal management and resource use in patients with acute myeloid leukaemia after chemotherapy--retrospective analysis of changes over 3 yr in a German hospital.
abstract: OBJECTIVE
  To describe changes in costs of managing hospitalised patients with acute myeloid leukaemia (AML) after chemotherapy in Germany over 3 yr, with a special focus on prophylaxis and treatment patterns as well as resource use related to invasive fungal infections (IFI).
  
  
  METHODS
  The study was conducted as a retrospective, single-centre chart review in patients with AML hospitalised for chemotherapy, neutropenia and infections after myelosuppressive chemotherapy from January 2004 to December 2006 in Germany. The following resource utilisation data were collected: inpatient stay, mechanical ventilation, parenteral feeding, diagnostics, systemic antifungal medication and cost-intensive concomitant medication. Direct medical costs were calculated from hospital provider perspective.
  
  
  RESULTS
  A total of 471 episodes in 212 patients were included in the analysis. Occurrence of IFI decreased from 5.9% in 2004 to 1.9% in 2006. Mean (± standard deviation) hospital stay decreased from 28.7 ± 17.9 d in 2004 to 22.4 ± 11.8 d in 2006. From 2004 to 2006, the use of a single antifungal drug increased from 30.4% to 46.9%, whereas the use of multiple antifungal drugs decreased from 24.4% to 13.1%. The use of liposomal amphotericin B declined between 2004 and 2006 (21.4% vs. 3.8%) and caspofungin between 2005 and 2006 (19.3% vs. 8.1%). Total costs per episode declined from €19051 ± 19024 in 2004 to €13531 ± 9260 in 2006; major reductions were observed in the use of antimycotics and blood products as well as length of hospital stay.
  
  
  CONCLUSIONS
  Analysis of real-life data from one single centre in Germany demonstrated a change in antifungal management of patients with AML between 2004/2005 and 2006, accompanied by a decline in total costs.
authors: Department of Medicine, Hematology/Oncology, Goethe-University, Frankfurt/Main, Germany. angelika.boehme@onkologikum.de
authors: Angelika
authors: A
authors: Böhme
authors: Johannes
authors: J
authors: Atta
authors: Sabine
authors: S
authors: Mousset
authors: Birgit
authors: B
authors: Ehlken
authors: Margarita
authors: M
authors: Shlaen
authors: Gesine
authors: G
authors: Bug
authors: Hubert
authors: H
authors: Serve
authors: Dieter
authors: D
authors: Hoelzer
mesh_terms: D000368:Aged; D000666:Amphotericin B / Q000008:administration & dosage / Q000191:economics; D000935:Antifungal Agents / Q000008:administration & dosage / Q000191:economics; D000077336:Caspofungin; D003365:Costs and Cost Analysis; D054714:Echinocandins / Q000008:administration & dosage / Q000191:economics; D005260:Female; D005858:Germany; D006761:Hospitals; D006801:Humans; D007902:Length of Stay; D015470:Leukemia, Myeloid, Acute / Q000188:drug therapy* / Q000191:economics*; D055666:Lipopeptides; D008297:Male; D008875:Middle Aged; D010288:Parenteral Nutrition / Q000191:economics; D012121:Respiration, Artificial / Q000191:economics; D012189:Retrospective Studies
chemical_list: D000935:Antifungal Agents; D054714:Echinocandins; D055666:Lipopeptides; D000666:Amphotericin B; D000077336:Caspofungin