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Changes in the utilization patterns of antifungal agents, medical cost and clinical outcomes of candidemia from the health-care benefit expansion to include newer antifungal agents

Authors
 Heun Choi  ;  Jung Ho Kim  ;  Hye Seong  ;  Woonji Lee  ;  Wooyong Jeong  ;  Jin Young Ahn  ;  Su Jin Jeong  ;  Nam Su Ku  ;  Joon Sup Yeom  ;  Young Keun Kim  ;  Hyo Youl Kim  ;  Young Goo Song  ;  June Myung Kim  ;  Jun Yong Choi 
Citation
 INTERNATIONAL JOURNAL OF INFECTIOUS DISEASES, Vol.83 : 49-55, 2019 
Journal Title
 INTERNATIONAL JOURNAL OF INFECTIOUS DISEASES 
ISSN
 1201-9712 
Issue Date
2019
Keywords
Antifungal agents ; Candidemia ; Echinocandins ; Health care costs ; Hospital mortality
Abstract
OBJECTIVES: In 2014, South Korea expanded its national health insurance coverage to include newer antifungal agents, such as echinocandins. This study aimed to investigate the effects of policy change on the prescription patterns of antifungals, medical costs and clinical outcomes of candidemia. METHODS: This retrospective cohort enrolled hospitalized patients with candidemia at three tertiary care hospitals in South Korea from January 2012 to December 2015. The utilization of antifungal agents, medical costs, length of hospital stay (LOS), and mortality before and after the health-care benefit expansion were compared, and the factors associated with all-cause 28-day mortality during the study period were analyzed. RESULTS: A total of 769 candidemia cases were identified. The incidence of candidemia did not significantly vary during the study period (P = 0.253). The proportion of echinocandins, as the initial antifungal agent, and medical costs associated with candidemia significantly increased since the change in insurance coverage (P < 0.001). There was no significant difference in LOS and mortality associated with candidemia before and after the health-care benefit expansion (P =  0.696 and 0.931, respectively). Multivariate logistic regression analysis showed that initial treatment with caspofungin was associated with decreased mortality (adjusted odds ratio: 0.784; 95% confidence interval: 0.681-0.902; reference: fluconazole). CONCLUSIONS: Although the utilization of newer antifungal agents and medical cost for candidemia has significantly increased since the health-care benefit expansion, there has been no change in the outcome of candidemia. However, the further increased use of newer antifungals may improve the outcome of candidemia in this country.
Full Text
https://www.clinicalkey.com/#!/content/playContent/1-s2.0-S1201971219301730
DOI
10.1016/j.ijid.2019.03.039
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
Yonsei Authors
Ku, Nam Su(구남수) ORCID logo https://orcid.org/0000-0002-9717-4327
Kim, Jung Ho(김정호) ORCID logo https://orcid.org/0000-0002-5033-3482
Kim, June Myung(김준명)
Seong, Hye(성혜) ORCID logo https://orcid.org/0000-0002-5633-7214
Song, Young Goo(송영구) ORCID logo https://orcid.org/0000-0002-0733-4156
Ahn, Jin Young(안진영) ORCID logo https://orcid.org/0000-0002-3740-2826
Yeom, Joon Sup(염준섭) ORCID logo https://orcid.org/0000-0001-8940-7170
Jeong, Su Jin(정수진) ORCID logo https://orcid.org/0000-0003-4025-4542
Choi, Jun Yong(최준용) ORCID logo https://orcid.org/0000-0002-2775-3315
Choi, Heun(최흔) ORCID logo https://orcid.org/0000-0002-9622-9381
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/170039
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