Direct treatment costs of invasive candidiasis in Haematology patients at a South African private hospital.

Abstract

ABSTRACT Background: Haematology patients are at a high risk of developing invasive candidiasis (IC). Fluconazole has been the mainstay of prophylaxis and treatment but recently a newer class of therapeutic options, the echinocandins, has seen a considerable improvement in treatment success. However, these agents are associated with substantial acquisition costs when compared to fluconazole. Objective: This study analysed the direct treatment costs of invasive candidiasis in haematology patients. Methods: This is a retrospective, single-centre economic analysis of haematology patients with IC, at a private hospital in Durban, KwaZulu-Natal province, South Africa.. The direct medical costs related to managing IC were analysed. These included antifungal administration costs, hospital ward costs, haematologist consultation costs and laboratory costs for blood cultures. Adult patients (≥18 years old) diagnosed with a haematology disorder and a positive blood culture for Candida who were prescribed fluconazole and/or an echinocandin as treatment were included in the study, patients in the three groups were analysed separately and compared. Results: There was a statistically significant difference for duration of antifungal treatment (p = 0.013) and antifungal administration costs (p = 0.003) between the three groups. Median overall direct treatment costs per patient were, ZAR110 365 for patients treated with fluconazole, ZAR219 915 for patients receiving an echinocandin and ZAR181 502 (for patients treated with both the antifungals. Overall hospital stay was the biggest cost contributor to the overall cost of treatment. Conclusion: The results of this cost analysis found that treatment with fluconazole only is considerably less expensive, almost half of the mean daily treatment cost, when compared to an echinocandin only and treatment using both agents is still less expensive than an echinocandin as first line therapy. 1