title: Cost Analysis of Fluconazole Prophylaxis for Prevention of Neonatal Invasive Candidiasis.
abstract: BACKGROUND
  Fluconazole prophylaxis (FP) in premature infants is well studied and has been shown to decrease invasive candidiasis (ICs). IC in neonates has significant financial costs; determining the cost-benefit of FP may provide additional justification for targeting high-risk neonates. We aimed to determine the IC rate in premature infants at which FP is cost-beneficial.
  
  
  METHODS
  A decision tree cost-analysis model using cost of FP related to costs associated with IC was used. We searched PubMed for all papers that used intravenous FP and reported rates of IC in very low birth weight neonates. Average IC rates in those who received FP (2.0%; range, 0-6.1%) and in those who did not receive FP (9.2%; range, 0-20.5%) were used. Incremental hospital costs because of IC and for FP were retrieved from the literature. Sensitivity analysis was performed to determine the incremental cost of FP across the range of published IC rates.
  
  
  RESULTS
  The average cost per patient attributed to IC in patients receiving FP was $785 versus $2617 in those not receiving FP. Sensitivity analysis demonstrates the rate of IC would need to be <2.8% for FP to lose its cost-benefit. In Monte Carlo simulation, targeting infants <1000 g would lead to $50,304,333 in cost savings per year in the United States.
  
  
  CONCLUSIONS
  FP provides a cost-advantage across most IC rates seen in the youngest premature infants. Using a rate of 2.8% for their individual high-risk neonatal intensive care unit patients, providers can determine if FP is cost-beneficial in determining for whom to provide IC prophylaxis.
authors.affiliation: From the *Division of Neonatology, Department of Pediatrics, and †Division of Cardiology, Department of Pediatrics, University of Virginia, Charlottesville, VA.
authors.forename: Jonathan R
authors.initials: JR
authors.lastname: Swanson
authors.forename: Jeff
authors.initials: J
authors.lastname: Vergales
authors.forename: David A
authors.initials: DA
authors.lastname: Kaufman
authors.forename: Robert A
authors.initials: RA
authors.lastname: Sinkin
mesh_terms: D000935:Antifungal Agents / Q000008:administration & dosage* / Q000191:economics; D058365:Candidiasis, Invasive / Q000191:economics / Q000453:epidemiology / Q000517:prevention & control*; D018890:Chemoprevention / Q000191:economics / Q000379:methods*; D003365:Costs and Cost Analysis; D005260:Female; D015725:Fluconazole / Q000008:administration & dosage* / Q000191:economics; D017721:Hospital Costs; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D000071074:Neonatal Sepsis / Q000191:economics / Q000453:epidemiology / Q000517:prevention & control*; D014481:United States
chemical_list: D000935:Antifungal Agents; D015725:Fluconazole