Direct Treatment Costs of Invasive Candidiasis in Haematology Patients at a South African Private Hospital

BACKGROUND- Haematology patients are at a high risk of developing invasive candidiasis (IC). Fluconazole has been the mainstay of prophylaxis and treatment with a newer class of therapeutic options, the echinocandins, having 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, comparing the costs between three groups depending on the treatment, namely, the fluconazole only group, the echinocandin only group or the group that was treated with both fluconazole and an echinocandin. To determine which variables contributed to the overall costs and whether there were differences between the groups. METHODS- This was a retrospective, single-centre economic analysis at a private hospital of patients with IC in the haematology ward in Durban, KwaZulu-Natal Province, South Africa. The direct medical costs related to managing IC were analysed. 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 treated with echinocandins, fluconazole or both classes of antifungals were analysed separately and compared. RESULTS- No statistically significant difference for duration of antifungal treatment or length of hospital stay between the three groups existed. Mean overall direct treatment costs per patient were- ZAR130 326 (95% CI- -4 932 – 265 584) for patients treated with fluconazole, ZAR241 165 (95% CI- 159 175 – 323 155) for patients receiving an echinocandin and ZAR270 802 (95% CI- 68 277 - 473 327) for patients treated with the combination 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, than an echinocandin only and treatment using both agents, is less expensive than an echinocandin only as first-line therapy.