Universität zu Köln

Heimann, S. M., Cornely, O. A., Wisplinghoff, H., Kochanek, M., Stippel, D., Padosch, S. A., Langebartels, G., Reuter, H., Reiner, M., Vierzig, A., Seifert, H., Vehreschild, M. J. G. T., Glossmann, J., Franke, B. and Vehreschild, J. J. (2015). Candidemia in the intensive care unit: analysis of direct treatment costs and clinical outcome in patients treated with echinocandins or fluconazole. Eur. J. Clin. Microbiol. Infect. Dis., 34 (2). S. 331 - 339. NEW YORK: SPRINGER. ISSN 1435-4373

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Abstract

Direct treatment costs caused by candidemia in German intensive care unit (ICU) patients are currently unknown. We analyzed treatment costs and the impact of antifungal drug choice. Comprehensive data of patients who had at least one episode of candidemia while staying in the ICU between 01/2005 and 12/2010 were documented in a database using the technology of the Cologne Cohort of Neutropenic Patients (CoCoNut). A detailed analysis of all disease-associated treatment costs was performed. Patients treated with echinocandins (i.e., anidulafungin, caspofungin, micafungin) or fluconazole were analyzed separately and compared. Forty-one and 64 patients received echinocandins and fluconazole, respectively. The mean Acute Physiology and Chronic Health Evaluation (APACHE) IV score was 114 (95 % confidence interval [CI]: 106-122) vs. 95 (95 % CI: 90-101, p = < 0.001). Twenty-three (56 %) and 33 (52 %, p = 0.448) patients survived hospitalization, while 17 (41 %) and 22 (34 %, p = 0.574) survived one year after diagnosis. In the echinocandin and fluconazole groups, the mean costs per patient of ICU treatment were a,not sign20,338 (95 % CI: a,not sign12,893-27,883) vs. a,not sign11,932 (95 % CI: a,not sign8,016-15,849, p = 0.110), and the total direct treatment costs per patient were a,not sign37,995 (95 % CI: a,not sign26,614-a,not sign49,376) vs. a,not sign22,305 (95 % CI: a,not sign16,817-a,not sign27,793, p = 0.012), resulting in daily costs per patient of a,not sign1,158 (95 % CI: a,not sign1,036-a,not sign1,280) vs. a,not sign927 (95 % CI: a,not sign828-a,not sign1,026, p = 0.001). Our health economic analysis shows the high treatment costs of patients with candidemia in the ICU. Sicker patients had a prolonged hospitalization and were more likely to receive echinocandins, leading to higher treatment costs. Outcomes were comparable to those achieved in less sick patients with fluconazole.

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Heimann, S. M. UNSPECIFIED UNSPECIFIED UNSPECIFIED Cornely, O. A. UNSPECIFIED UNSPECIFIED UNSPECIFIED Wisplinghoff, H. UNSPECIFIED UNSPECIFIED UNSPECIFIED Kochanek, M. UNSPECIFIED UNSPECIFIED UNSPECIFIED Stippel, D. UNSPECIFIED UNSPECIFIED UNSPECIFIED Padosch, S. A. UNSPECIFIED UNSPECIFIED UNSPECIFIED Langebartels, G. UNSPECIFIED UNSPECIFIED UNSPECIFIED Reuter, H. UNSPECIFIED UNSPECIFIED UNSPECIFIED Reiner, M. UNSPECIFIED UNSPECIFIED UNSPECIFIED Vierzig, A. UNSPECIFIED UNSPECIFIED UNSPECIFIED Seifert, H. UNSPECIFIED UNSPECIFIED UNSPECIFIED Vehreschild, M. J. G. T. UNSPECIFIED UNSPECIFIED UNSPECIFIED Glossmann, J. UNSPECIFIED UNSPECIFIED UNSPECIFIED Franke, B. UNSPECIFIED UNSPECIFIED UNSPECIFIED Vehreschild, J. J. UNSPECIFIED UNSPECIFIED UNSPECIFIED
URN:	urn:nbn:de:hbz:38-413614
DOI:	10.1007/s10096-014-2230-8
Journal or Publication Title:	Eur. J. Clin. Microbiol. Infect. Dis.
Volume:	34
Number:	2
Page Range:	S. 331 - 339
Date:	2015
Publisher:	SPRINGER
Place of Publication:	NEW YORK
ISSN:	1435-4373
Language:	English
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language INVASIVE CANDIDIASIS; ANTIFUNGAL THERAPY; APACHE-II; EPIDEMIOLOGY; CANDIDAEMIA; IMPACT; SUSCEPTIBILITY; MICAFUNGIN; MANAGEMENT; INFECTION Multiple languages Infectious Diseases; Microbiology Multiple languages
URI:	http://kups.ub.uni-koeln.de/id/eprint/41361