DGI-036 Evolution of Antifungal Consumption in a General Hospital

Abstract

Background Antifungal treatment is an important part of global expenditure. A significant increase in the use of these drugs does entail a higher cost. It is hoped that the use of these drugs will continue to increase each year. It is important to know the drug use distribution through the different units and the monetary cost in order to put forward pharmacist interventions. Purpose To describe the evolution of expenditure on, and consumption of, caspofungin, voriconazole, amphotericin B and fluconazole and significant fungaemia from 2009 to 2011. Materials and Methods Observational, retrospective study, carried out in a General Hospital. The consumption for every single patient of caspofungin, voriconazole, liposomal amphotericin B and fluconazole, from 2009 to 2011, were obtained from the Pharmacy Department Software databases (Langtools). Average prices were used to calculate the financial impact. In the microbiology department, blood cultures were done for every patient treated with these drugs for fungal isolates. Results Pharmaceutical spending on these four drugs versus general expenditure was 1.53%, 1.04% and 1.00% for the years 2009, 2010 and 2011 respectively. The evolution of consumption in units (including all presentations) and expenditure is shown in the following table (table 1). The total consumption of the main services in the study period is shown in the following table (table 2). The number of yeasts isolated from blood cultures was 20, 19 and 21 for the years 2009, 2010 and 2011 respectively, representing 2.48% of all positive blood cultures. Abstract DGI-036 Table 1 Units 2009 Spending 2009 (€) Units 2010 Spending 2010 (€) Units 2011 Spending 2011(€) Caspofungin 50 mg vial 426 198,935.95 218 94,934.03 148 64.714,53 Voriconazole 200 mg vial 541 41,914.25 468 37,146.39 731 44.453,75 Liposomal Amphotericin B 50 mg vial 1456 142,091.04 1353 132,042.78 1792 174.885,93 Fluconazole 400 mg vial 2759 4,566.79 2701 4,799.73 2623 4.711,38 Total 5182 387,508.03 4740 268,922.93 5294 288,765.59 Total pharmaceutical expenditure 25,310,713 25,824,331 28,771,067 Abstract DGI-036 Table 2 Units 2009 Spending 2009 (€) Units 2010 Spending 2010 (€) Units 2011 Spending 2011(€) Caspofungin 50 mg vial 426 198,935.95 218 94,934.03 148 64.714,53 Voriconazole 200 mg vial 541 41,914.25 468 37,146.39 731 44.453,.75 Liposomal Amphotericin B 50 mg vial 1456 142,091.04 1353 132,042.78 1792 174.885.93 Fluconazole 400 mg vial 2759 4,566.79 2701 4,799.73 2623 4.711,38 Total 5182 387,508.03 4740 268,922.93 5294 288,765.59 Total pharmaceutical expenditure 25,310,713 25,824,331 28,771,067 Conclusions Antifungal spending is disproportionately high considering the low number of fungal isolates, and entails a high use of empirical and prophylactic treatment. Haematology is, by far, the main department responsible for the use of antifungal treatment. Consumption of voriconazole and liposomal amphotericin B are increasing, meanwhile caspofungin is decreasing in recent years. No confl...