Hospital costs and outcomes among intravenous antifungal therapies for patients with invasive aspergillosis in the United States
Hospital costs and outcomes among intravenous antifungal therapies for patients with invasive aspergillosis in the United States
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DOI：
10.1111/j.1439-0507.2010.01903.x
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发表时间：
2011-09-01
期刊：
影响因子：
4.9
通讯作者：
Kuti, Joseph L.
中科院分区：
文献类型：
--
作者：
Kim, Aryun;Nicolau, David P.;Kuti, Joseph L.
这项研究确定了在美国引进新的抗真菌治疗的几年中曲霉菌病相关住院的经济负担。使用Premier Perspective（TM）数据库中的国家管理数据，从医院角度进行了一项回顾性观察性队列研究。在2000年至2006年期间接受至少3天静脉内抗真菌治疗的1835例住院患者（n = 1603）中编码为曲霉菌属感染。所有费用都被夸大到2006年的美元。根据初始抗真菌治疗分层后，比较住院时间、住院费用和死亡率。中位住院费用为52 803美元（25 929-100 730），在研究期间每年没有差异。静脉抗真菌药占曲霉菌病相关住院费用的7.2%（范围：0.78-15.9%）。粗死亡率为36.7%，是研究的最后2年（2005年，2006年）中最低的。虽然抗真菌药物的使用在研究过程中发生了变化，但最初的抗真菌药物选择与粗死亡率并不独立相关。相比之下，静脉注射伏立康唑的初始治疗与总住院费用和住院时间的减少有关。阿替霉素B脂质复合物或卡泊芬净治疗也与住院时间缩短独立相关。在这项大型美国研究中，曲霉菌病相关住院的死亡率和费用相当可观，但抗真菌药占治疗相关总费用的一小部分，并且不会独立影响住院粗死亡率。只有静脉注射伏立康唑的初始治疗与总住院费用的降低相关。
This study determined the economic burden of aspergillosis-related hospitalisations in the United States during years when new antifungal treatments were introduced. A retrospective observational cohort study from the hospital perspective was conducted using national administrative data from the Premier Perspective (TM) Database. Patients (n = 1603) coded for infection caused by Aspergillus species during 1835 admissions who received at least 3 days of intravenous antifungal therapy between 2000 and 2006 were included. All costs were inflated to $US 2006. Length of stay, hospital costs and mortality were compared after stratification by initial antifungal therapy. Median hospital costs were $52 803 (25 929-100 730) and did not differ by year over the study period. Intravenous antifungals accounted for 7.2% (range: 0.78-15.9%) of the cost of aspergillosis-related hospitalisation. Crude mortality was 36.7% and was the lowest in the last 2 years of the study (2005, 2006). Although antifungal utilisation changed over the course of the study, initial antifungal choice was not independently associated with crude mortality. In contrast, initial therapy with intravenous voriconazole was associated with reduced total hospitalisation costs and length of hospital stay. Treatment with amphotericin B lipid complex or caspofungin was also independently associated with a reduced length of hospital stay. In this large US study, mortality and costs for aspergillosis-related hospitalisations were considerable, but antifungals accounted for a small percentage of total costs associated with treatment and did not independently affect in-hospital crude mortality. Only initial treatment with intravenous voriconazole was associated with reduced total hospitalisation costs.