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Fluconazole cost-effective in treatment of neonatal invasive candidiasis
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Fluconazole was cost-effective in the treatment of invasive candidiasis for neonatal ICU patients if at least 2.8% of those in the unit had the disease, according to findings published in The Pediatric Infectious Disease Journal.
“Invasive candidiasis in the extremely premature infant population has a high rate of morbidity and mortality,” Jonathan R. Swanson, MD, MSc, medical director of the NICU at the University of Virginia Children’s Hospital, told Infectious Diseases in Children. “This study is the first to demonstrate from a population view that fluconazole prophylaxis provides a significant cost benefit to those units who use it to prevent fungal infections.”
Jonathan R. Swanson
Although invasive candidiasis (IC) has declined in infants, its incidence has increased in NICUs, most likely due to the increased survivability of extremely low-birth-weight infants, Swanson and colleagues wrote. This population has an overall mortality rate of 41% when infected with the disease, they said, and IC causes $44 million to $320 million in excess hospital costs for infants who survive until adulthood.
In previous studies of premature infants, fluconazole prophylaxis (FP) decreased IC rates by up to 90%. Still, only 30% to 50% of NICUs use some form of antifungal prophylaxis, the investigators wrote.
To determine the cost-benefit threshold of FP use in NICU patients, Swanson and colleagues created a decision tree cost-analysis model. After searching PubMed for studies that used intravenous FP in very low-birth-weight infants with IC, the researchers found that the average IC rate was 2% for infants who had received FP and 9.2% for infants who had not received FP. After analyzing hospital costs, the researchers performed a sensitivity analysis to determine the incremental cost of FP for the published IC rates. They also performed a Monte Carlo simulation to calculate potential savings from FP.
They determined that the average hospital cost per person for patients with IC treated with FP was $785 vs. $2,617 for IC patients not treated with FP. In sensitivity analysis, the researchers found that less than 2.8% of patients would need to have IC in order for FP to become cost-inefficient. In the Monte Carlo simulation, the researchers wrote that U.S. hospitals would save $50,304,333 annually if FP became universally used in infants weighing less than 1,000 grams.
They wrote that individual clinicians should determine if FP is cost beneficial for their own high-risk NICU patients with IC by using the threshold rate of 2.8%.
“This analysis provides more evidence of the need for targeted use of FP in preventing IC,” Swanson and colleagues wrote. “Although individual NICU IC rates vary widely, each NICU should investigate what subgroup of infants are at highest risk.” – by Will Offit
Disclosure: The researchers report no relevant financial disclosures.
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