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Candidemia in the intensive care unit: analysis of direct treatment costs and clinical outcome in patients treated with echinocandins or fluconazole

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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 €20,338 (95 % CI: €12,893–27,883) vs. €11,932 (95 % CI: €8,016–15,849, p = 0.110), and the total direct treatment costs per patient were €37,995 (95 % CI: €26,614–€49,376) vs. €22,305 (95 % CI: €16,817–€27,793, p = 0.012), resulting in daily costs per patient of €1,158 (95 % CI: €1,036–€1,280) vs. €927 (95 % CI: €828–€1,026, 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.

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Funding

This study was supported by an unrestricted research grant from Pfizer Pharma GmbH, Germany. It was designed, planned, and performed by the academic authors and students of the University Hospital of Cologne.

Conflict of interest

S.M.H. has received research and travel grants from Astellas and Merck, and travel grants from Pfizer. O.A.C. is supported by the German Federal Ministry of Research and Education (BMBF grant 01KN1106), has received research grants from 3M, Actelion, Astellas, Basilea, Bayer, BioCryst, Celgene, Cubist, F2G, Genzyme, Gilead, GSK, Merck/Schering, Miltenyi, Optimer, Pfizer, Quintiles, and ViroPharma, is a consultant to 3M, Astellas, Basilea, Cubist, F2G, Gilead, GSK, Merck/Schering, Optimer, Pfizer, and Sanofi Pasteur, and received lecture honoraria from Astellas, Gilead, Merck/Schering, and Pfizer. J.J.V. has received research grants from Astellas, Gilead, Infectopharm, Merck/Schering, and Pfizer, and has received lecture honoraria from Astellas, Gilead, Merck/Schering, and Pfizer. M.J.G.T.V. has received research grants from 3M and has received lecture honoraria from Astellas Pharma, Gilead Sciences, Merck/MSD, and Pfizer. M.K. has received lecture honoraria from Astellas, Merck/MSD, and Pfizer. H.S. has received funding from the Bundesministerium für Bildung und Forschung (BMBF), Germany, Klinische Forschergruppe Infektiologie (grant no. 01 KI 0771), Basilea, Novartis, and Pfizer, has been a consultant for Astellas, AstraZeneca, Basilea, Cubist, MSD, Novartis, Pfizer, and Theravance, and has served on the speakers’ bureaus of Astellas, AstraZeneca, Gilead, MSD, Novartis, and Pfizer. S.A.P., H.W., G.L., M.R., D.S., H.R., B.F., A.V., and J.G. declare not to have relevant conflicts of interest.

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Authors and Affiliations

  1. 1st Department of Internal Medicine, University Hospital of Cologne, Kerpener Straße 62, 50937, Cologne, Germany

    S. M. Heimann, O. A. Cornely, M. Kochanek, M. J. G. T. Vehreschild, J. Glossmann, B. Franke & J. J. Vehreschild

  2. Clinical Trials Centre Cologne, ZKS Köln, Cluster of Excellence—Cellular Stress Responses in Aging-Associated Diseases, CECAD—BMBF01KN1106, University Hospital of Cologne, Herderstraße 52-54, 50931, Cologne, Germany

    O. A. Cornely

  3. Center for Integrated Oncology Köln Bonn, CIO Köln Bonn, University Hospital of Cologne, 50924, Cologne, Germany

    O. A. Cornely & J. Glossmann

  4. German Centre for Infection Research, partner site Bonn-Cologne, Cologne, Germany

    O. A. Cornely, H. Seifert, M. J. G. T. Vehreschild, B. Franke & J. J. Vehreschild

  5. Institute for Medical Microbiology, Immunology and Hygiene, University Hospital of Cologne, Goldenfelsstraße 19-21, 50935, Cologne, Germany

    H. Wisplinghoff & H. Seifert

  6. Department of General, Visceral and Cancer Surgery, University of Cologne, 50924, Cologne, Germany

    D. Stippel

  7. Department of Anaesthesiology and Postoperative Intensive Care Medicine, University of Cologne, 50924, Cologne, Germany

    S. A. Padosch

  8. Department for Cardiothoracic Surgery, Heart Center of the University of Cologne, Kerpener Str. 62, 50924, Cologne, Germany

    G. Langebartels

  9. Department of Internal Medicine III, University Hospital of Cologne, 50924, Cologne, Germany

    H. Reuter

  10. Department of Neurosurgery, University Hospital Cologne, 50924, Cologne, Germany

    M. Reiner

  11. Department of Neonatology and Pediatric Intensive Care, Childrens’s Hospital, University of Cologne, 50924, Cologne, Germany

    A. Vierzig

Authors
  1. S. M. Heimann
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  2. O. A. Cornely
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  3. H. Wisplinghoff
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  4. M. Kochanek
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  5. D. Stippel
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  6. S. A. Padosch
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  7. G. Langebartels
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  8. H. Reuter
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  9. M. Reiner
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  10. A. Vierzig
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  11. H. Seifert
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  12. M. J. G. T. Vehreschild
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  13. J. Glossmann
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  14. B. Franke
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  15. J. J. Vehreschild
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Correspondence to J. J. Vehreschild.

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Heimann, S.M., Cornely, O.A., Wisplinghoff, H. et al. 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, 331–338 (2015). https://doi.org/10.1007/s10096-014-2230-8

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  • DOI: https://doi.org/10.1007/s10096-014-2230-8

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