Potential clinical and economic outcomes of active beta-D-glucan surveillance with preemptive therapy for invasive candidiasis at intensive care units: a decision model analysis.
Early initiation of antifungal treatment for invasive candidiasis is associated with change in mortality. Beta-D-glucan (BDG) is a fungal cell wall component and a serum diagnostic biomarker of fungal infection. Clinical findings suggested an association between reduced invasive candidiasis incidence in intensive care units (ICUs) and BDG-guided preemptive antifungal therapy. We evaluated the potential cost-effectiveness of active BDG surveillance with preemptive antifungal therapy in patients admitted to adult ICUs from the perspective of Hong Kong healthcare providers. A Markov model was designed to simulate the outcomes of active BDG surveillance with preemptive therapy (surveillance group) and no surveillance (standard care group). Candidiasis-associated outcome measures included mortality rate, quality-adjusted life year (QALY) loss, and direct medical cost. Model inputs were derived from the literature. Sensitivity analyses were conducted to evaluate the robustness of model results. In base-case analysis, the surveillance group was more costly (1387 USD versus 664 USD) (1 USD = 7.8 HKD), with lower candidiasis-associated mortality rate (0.653 versus 1.426 per 100 ICU admissions) and QALY loss (0.116 versus 0.254) than the standard care group. The incremental cost per QALY saved by the surveillance group was 5239 USD/QALY. One-way sensitivity analyses found base-case results to be robust to variations of all model inputs. In probabilistic sensitivity analysis, the surveillance group was cost-effective in 50 % and 100 % of 10,000 Monte Carlo simulations at willingness-to-pay (WTP) thresholds of 7200 USD/QALY and ≥27,800 USD/QALY, respectively. Active BDG surveillance with preemptive therapy appears to be highly cost-effective to reduce the candidiasis-associated mortality rate and save QALYs in the ICU setting.
School of Pharmacy, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, NT, Hong Kong.
Y-K
YK
Pang
Department of Microbiology, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, NT, Hong Kong.
M
M
Ip
School of Pharmacy, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, NT, Hong Kong. joyceyou@cuhk.edu.hk.
J H S
JHS
You
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000935:Antifungal Agents / Q000191:economics / Q000627:therapeutic use*; D058365:Candidiasis, Invasive / Q000175:diagnosis* / Q000517:prevention & control*; D018890:Chemoprevention / Q000191:economics / Q000379:methods*; D003362:Cost-Benefit Analysis; D003661:Decision Support Techniques; D003955:Diagnostic Tests, Routine / Q000191:economics / Q000379:methods*; D005260:Female; D017048:Health Care Costs; D006723:Hong Kong; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D016896:Treatment Outcome; D055815:Young Adult; D047071:beta-Glucans / Q000097:blood*
D000935:Antifungal Agents; D047071:beta-Glucans
Korean J Intern Med. 2009 Sep;24(3):263-9
19721864
BMJ. 2011 Apr 11;342:d1766
21482590
Clin Infect Dis. 2011 Mar 15;52(6):750-70
21367728
Antimicrob Agents Chemother. 2005 Sep;49(9):3640-5
16127033
Clin Microbiol Infect. 2012 Dec;18 Suppl 7:19-37
23137135
Med Care. 1998 Jun;36(6):778-92
9630120
Crit Care Med. 2009 May;37(5):1612-8
19325476
Clin Infect Dis. 2006 Jul 1;43(1):25-31
16758414
Clin Infect Dis. 2014 May;58(9):1219-26
24550378
Crit Care. 2009;13(4):R115
19594912
Hong Kong Med J. 2009 Aug;15(4):255-61
19652231
Infect Dis Clin North Am. 2006 Sep;20(3):485-506
16984866
JAMA. 2009 Dec 2;302(21):2323-9
19952319
J Clin Microbiol. 1996 Aug;34(8):1918-21
8818881
J Clin Microbiol. 2005 Jan;43(1):299-305
15634986
Am J Infect Control. 2016 Apr 1;44(4):394-9
26698671
Eur J Clin Microbiol Infect Dis. 2006 Jul;25(7):419-25
16773391
Value Health. 2010 Dec;13(8):1028-37
20667054
PLoS One. 2012;7(8):e42282
22879929
Med Decis Making. 1993 Oct-Dec;13(4):322-38
8246705
Clin Microbiol Infect. 2012 Dec;18 Suppl 7:9-18
23137134
Crit Care Med. 2011 Apr;39(4):665-70
21169817
Virulence. 2014 Jan 1;5(1):161-9
24157707
Eur J Clin Microbiol Infect Dis. 2015 May;34(5):951-61
25577175
Am J Infect Control. 2014 Apr;42(4):412-6
24679568
Crit Care Med. 2002 Aug;30(8):1808-14
12163798
Clin Infect Dis. 2004 Aug 1;39(3):309-17
15306996
Clin Infect Dis. 2004 Jul 15;39(2):199-205
15307029
Infect Control Hosp Epidemiol. 2012 Oct;33(10):1024-30
22961022
Educ Health (Abingdon). 2003 Jul;16(2):230
14741909
Anaesthesia. 2007 Jun;62(6):547-54
17506731
Clin Infect Dis. 2012 Jun;54(12):1739-46
22423135
Med Mycol. 2011 Feb;49(2):113-20
20818922
Eur J Clin Microbiol Infect Dis. 2004 Apr;23(4):323-30
15024623
J Crit Care. 2013 Feb;28(1):2-8
22999484
Clin Infect Dis. 2009 Mar 1;48(5):503-35
19191635