Impact of Invasive Fungal Infections on Mortality, Length of Hospital Stay, and Costs in Allogeneic Hematopoietic Stem Cell Transplant Patients

Cai, Jenny; Prehn, Angela W.; Schlamm, Haran T.; Mucci, Massimiliano; Ferraro, Aimee

doi:10.1016/j.bbmt.2013.12.364

Cited by 2 publications

(3 citation statements)

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“…Treatment of IFIs is associated with significant healthcare resource utilization (HCRU) and costs, resulting in a high economic burden 4,7,[12][13][14][15][16][17][18] ; however, studies that have evaluated the economic impact of the index hospitalization are lacking.…”

Section: Introductionmentioning

confidence: 99%

Healthcare resource utilization and economic burden of antifungal management in patients with hematologic malignancy in Japan: a retrospective database study

Ueno

Nishimura

Fujimoto

et al. 2021

Current Medical Research and Opinion

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Objective: To examine treatment patterns of real-world antifungal management of patients at high risk of invasive fungal infections (IFI) and evaluate healthcare resource utilization and costs associated with antifungal management of IFIs in Japan. Methods: This retrospective, observational study extracted data from a hospital-based claims database for patients in Japan who either (a) underwent allogeneic hematopoietic stem cell transplantation (allo-HSCT), or (b) were hospitalized with acute myeloid leukemia (AML) or myelodysplastic syndromes (MDS) and received chemotherapy during the study period of January 2010 to January 2019. Results: 863 patients were included in the allo-HSCT cohort and 4498 patients were included in the AML/MDS cohort. In the allo-HSCT cohort, 91% received more than one antifungal drug during the index hospitalization. In the AML/MDS cohort, approximately 50% received more than one antifungal drug during the index hospitalization. For both the allo-HSCT and AML/MDS cohorts, about 90% of the total cost was attributed to inpatient costs. Of note, both the total cost (the total inpatient and outpatient cost) and the index hospitalization costs were higher in patients treated with multiple antifungal drugs than in those treated with a single antifungal drug during the index hospitalization. Despite being at high IFI risk, 12% of the patients in the AML/MDS cohort did not receive antifungal drugs during the index hospitalization. Conclusions: Most patients with hematologic malignancy and high IFI risk underwent complicated antifungal management requiring use of multiple drugs, and accounted for high healthcare resource utilization and costs.

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Section: Introductionmentioning

confidence: 99%

Healthcare resource utilization and economic burden of antifungal management in patients with hematologic malignancy in Japan: a retrospective database study

Ueno

Nishimura

Fujimoto

et al. 2021

Current Medical Research and Opinion

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“…Prior to introduction of antifungal prophylaxis, rates of IFIs, including aspergillosis, were 15–20% . The additional costs of IFI treatment in an immunocompromised patient places a heavy burden on patients and the healthcare system . Due to high IFI rates, associated comorbidities, increased mortality, and challenges associated with timely IFI diagnosis and early treatment initiation, antifungal prophylaxis is an essential component of post‐HCT care …”

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confidence: 99%

“…3,4 The additional costs of IFI treatment in an immunocompromised patient places a heavy burden on patients and the healthcare system. 5 Due to high IFI rates, associated comorbidities, increased mortality, and challenges associated with timely IFI diagnosis and early treatment initiation, antifungal prophylaxis is an essential component of post-HCT care. [6][7][8] Voriconazole is a triazole antifungal agent with broad-spectrum activity that encompasses yeasts and molds, including aspergillosis.…”

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confidence: 99%

Evaluation of CYP2C19 Genotype‐Guided Voriconazole Prophylaxis After Allogeneic Hematopoietic Cell Transplant

Patel

Hamadeh

Robinson

et al. 2019

Clin Pharma and Therapeutics

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There is a high risk of voriconazole failure in those with subtherapeutic drug concentrations, which is more common in CYP2C19 (cytochrome P450 2C19) rapid/ultrarapid metabolizers (RMs/UMs). We evaluated CYP2C19 genotype‐guided voriconazole dosing on drug concentrations and clinical outcomes in adult allogeneic hematopoietic cell transplant recipients. Poor (PMs), intermediate (IMs), and normal metabolizers (NMs) received voriconazole 200 mg twice daily; RMs/UMs received 300 mg twice daily. Steady‐state trough concentrations were obtained after 5 days, targeting 1.0–5.5 mg/L. Of 89 evaluable patients, 29% had subtherapeutic concentrations compared with 50% in historical controls (P < 0.001). Zero, 26%, 50%, and 16% of PMs, IMs, NMs, and RMs/UMs were subtherapeutic. Voriconazole success rate was 78% compared with 54% in historical controls (P < 0.001). No patients experienced an invasive fungal infection (IFI). Genotype‐guided dosing resulted in $4,700 estimated per patient savings as compared with simulated controls. CYP2C19 genotype‐guided voriconazole dosing reduced subtherapeutic drug concentrations and effectively prevented IFIs.

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Impact of Invasive Fungal Infections on Mortality, Length of Hospital Stay, and Costs in Allogeneic Hematopoietic Stem Cell Transplant Patients

Cited by 2 publications

References 0 publications

Healthcare resource utilization and economic burden of antifungal management in patients with hematologic malignancy in Japan: a retrospective database study

Healthcare resource utilization and economic burden of antifungal management in patients with hematologic malignancy in Japan: a retrospective database study

Evaluation of CYP2C19 Genotype‐Guided Voriconazole Prophylaxis After Allogeneic Hematopoietic Cell Transplant

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