Background The recent marketing of new high-cost antifungal agents (echinocandins and azoles) requires the design of cost-effective treatment protocols.
Purpose A new treatment guide for candidaemia and other invasive fungal infections for non-haematology adult patients was approved in June 2011. The main objective was to evaluate the cost reduction by introducing this protocol in a 737-bed University Hospital serving a population of more than 400,000 inhabitants.
Materials and Methods Retrospective observational study between June and December 2011. We reviewed the medical records of patients whom were prescribed antifungal treatment during that time and we assessed the adjustment to the approved treatment guidelines. To quantify the avoided costs we extracted consumption data and costs of antifungals from the pharmacy service management system (SAP®) and compared them with the same period the previous year.
Results During the study 43 non-haematology patients were treated with antifungal agents. In 38 patients (88.4%) the approved treatment guidelines were followed and in 5 patients (11.6%) they were breached.The most significant breaches occurred in internal medicine (22.2%) and in critical care (3.7%).
Regarding avoided costs for the six months of the study, antifungal costs were reduced by 240,616 euros. We observed a 61.9% and 48% increase in use in fluconazole and anidulafungin, and a 42.8% and 41.7% decrease in caspofungin and liposomal amphotericin B use. These results are consistent with the recommendations contained in the guide (first line use of fluconazole in non-immunosuppressed patients and in azole resistance use anidulafungin). Micafungin use was restricted to the paediatric population with consumption equal to that in the previous period.
Conclusions The treatment guideline compliance was excellent at our hospital, resulting in a significant decrease in antifungal expenses. Implementation of these guidelines in the management of high-cost drugs resulted in significant cost reductions and therefore in a more rational use of healthcare budgets.
No conflict of interest.
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