Health economic analysis of patients treated with isavuconazole in a German comprehensive cancer centre.
antifungal treatment
cost analysis
invasive aspergillosis
invasive fungal diseases
isavuconazole
mucormycosis
Journal
Mycoses
ISSN: 1439-0507
Titre abrégé: Mycoses
Pays: Germany
ID NLM: 8805008
Informations de publication
Date de publication:
May 2023
May 2023
Historique:
revised:
12
01
2023
received:
21
08
2022
accepted:
13
01
2023
medline:
4
4
2023
pubmed:
22
1
2023
entrez:
21
1
2023
Statut:
ppublish
Résumé
Invasive fungal diseases (IFD) are life-threatening and demand timely and appropriate treatment. Research showed that isavuconazole treatment positively affects clinical outcome and length of hospital stay (LOS). The aim of this study was to assess the hospital costs of patients diagnosed with IFD and treated with isavuconazole using real-world data from a German cancer centre. Data and LOS collected from Jan-2016 to Jun-2021 at Department I of Internal Medicine, University Hospital Cologne were retrieved. Case-related resources consumed during the hospital stay across isavuconazole routes of administration (oral, parenteral, and mixed administration) were identified, quantified, valued and compared via a cost analysis that adopted the healthcare payer perspective. In total, 101 cases with isavuconazole treatment were identified (oral: n = 22, 21.8%; parenteral: n = 59, 58.4%; mixed: n = 20, 19.8%). Median total LOS was greater in the mixed group (46.5 days; p = .009). Median ICU LOS and ventilation duration were both longest in the parenteral-only group (16 days, p = .008; 224 h, p = .003). Invasive aspergillosis was the most frequent isavuconazole indication (n = 86, 85.2%). Average hospital costs were highest in the mixed group (€ 101,226). The median overall costs of cases treated with isavuconazole was € 52,050. Treating IFD is resource intensive, often requires intensive care and implies high rates of in-hospital mortality. Our study emphasises the high hospital treatment costs and thus the need for reimbursement systems to enable live-saving costly treatments.
Sections du résumé
BACKGROUND
BACKGROUND
Invasive fungal diseases (IFD) are life-threatening and demand timely and appropriate treatment. Research showed that isavuconazole treatment positively affects clinical outcome and length of hospital stay (LOS).
OBJECTIVES
OBJECTIVE
The aim of this study was to assess the hospital costs of patients diagnosed with IFD and treated with isavuconazole using real-world data from a German cancer centre.
PATIENTS/METHODS
METHODS
Data and LOS collected from Jan-2016 to Jun-2021 at Department I of Internal Medicine, University Hospital Cologne were retrieved. Case-related resources consumed during the hospital stay across isavuconazole routes of administration (oral, parenteral, and mixed administration) were identified, quantified, valued and compared via a cost analysis that adopted the healthcare payer perspective.
RESULTS
RESULTS
In total, 101 cases with isavuconazole treatment were identified (oral: n = 22, 21.8%; parenteral: n = 59, 58.4%; mixed: n = 20, 19.8%). Median total LOS was greater in the mixed group (46.5 days; p = .009). Median ICU LOS and ventilation duration were both longest in the parenteral-only group (16 days, p = .008; 224 h, p = .003). Invasive aspergillosis was the most frequent isavuconazole indication (n = 86, 85.2%). Average hospital costs were highest in the mixed group (€ 101,226). The median overall costs of cases treated with isavuconazole was € 52,050.
CONCLUSIONS
CONCLUSIONS
Treating IFD is resource intensive, often requires intensive care and implies high rates of in-hospital mortality. Our study emphasises the high hospital treatment costs and thus the need for reimbursement systems to enable live-saving costly treatments.
Substances chimiques
isavuconazole
60UTO373KE
Antifungal Agents
0
Triazoles
0
Nitriles
0
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
405-411Subventions
Organisme : Pfizer
Informations de copyright
© 2023 The Authors. Mycoses published by Wiley-VCH GmbH.
Références
von Lilienfeld-Toal M, Wegener J, Einsele H, Cornely OA, Kurzai O. Invasive fungal infection. Dtsch Arztebl Int. 2019;116(16):271-278.
Cuenca-Estrella M, Bernal-Martinez L, Isla G, Gomez-Lopez A, Alcazar-Fuoli L, Buitrago MJ. Incidence of zygomycosis in transplant recipients. Clin Microbiol Infect. 2009;15:37-40.
Puerta-Alcalde P, Garcia-Vidal C. Changing epidemiology of invasive fungal disease in allogeneic hematopoietic stem cell transplantation. J Fungi (Basel). 2021;7(10):848.
Maschmeyer G, Haas A, Cornely OA. Invasive aspergillosis. Drugs. 2007;67(11):1567-1601.
Guinea J, Escribano P, Vena A, et al. Increasing incidence of mucormycosis in a large Spanish hospital from 2007 to 2015: epidemiology and microbiological characterization of the isolates. PLoS One. 2017;12(6):e0179136.
Bitar D, Van Cauteren D, Lanternier F, et al. Increasing incidence of zygomycosis (mucormycosis), France, 1997-2006. Emerg Infect Dis. 2009;15(9):1395-1401.
Saegeman V, Maertens J, Meersseman W, Spriet I, Verbeken E, Lagrou K. Increasing incidence of mucormycosis in university hospital, Belgium. Emerg Infect Dis. 2010;16(9):1456-1458.
European Medicines Agency. Summary of Product Characteristics (Cresemba). 2021; https://www.ema.europa.eu/en/documents/product-information/cresemba-epar-product-information_en.pdf. Accessed May 03, 2022.
Patterson TF, Thompson GR 3rd, Denning DW, et al. Practice guidelines for the diagnosis and management of aspergillosis: 2016 update by the infectious diseases society of America. Clin Infect Dis. 2016;63(4):e1-e60.
Ullmann A, Aguado J, Arikan-Akdagli S, et al. Diagnosis and management of aspergillus diseases: executive summary of the 2017 ESCMID-ECMM-ERS guideline. Clin Microbiol Infect. 2018;24:e1-e38.
Cornely OA, Alastruey-Izquierdo A, Arenz D, et al. Global guideline for the diagnosis and management of mucormycosis: an initiative of the European Confederation of Medical Mycology in cooperation with the mycoses study group education and research consortium. Lancet Infect Dis. 2019;19(12):e405-e421.
Ananda-Rajah MR, Cheng A, Morrissey CO, et al. Attributable hospital cost and antifungal treatment of invasive fungal diseases in high-risk hematology patients: an economic modeling approach. Antimicrob Agents Chemother. 2011;55(5):1953-1960.
Heimann SM, Vehreschild M, Cornely OA, et al. Healthcare burden of probable and proven invasive mucormycosis: a multi-Centre cost-of-illness analysis of patients treated in tertiary care hospitals between 2003 and 2016. J Hosp Infect. 2019;101(3):339-346.
Valentine JC, Morrissey CO, Tacey MA, Liew D, Patil S, Ananda-Rajah M. A population-based analysis of attributable hospitalisation costs of invasive fungal diseases in haematological malignancy patients using data linkage of state-wide registry and costing databases: 2009-2015. Mycoses. 2020;63(2):162-171.
Azanza JR, Grau S, Vázquez L, et al. The cost-effectiveness of isavuconazole compared to voriconazole, the standard of care in the treatment of patients with invasive mould diseases, prior to differential pathogen diagnosis in Spain. Mycoses. 2021;64(1):66-77.
Harrington R, Lee E, Yang H, et al. Cost-effectiveness analysis of isavuconazole vs. voriconazole as first-line treatment for invasive aspergillosis. Adv Ther. 2017;34(1):207-220.
Floros L, Kuessner D, Posthumus J, Bagshaw E, Sjölin J. Cost-effectiveness analysis of isavuconazole versus voriconazole for the treatment of patients with possible invasive aspergillosis in Sweden. BMC Infect Dis. 2019;19(1):134.
Drummond MF, Sculpher MJ, Claxton K, Stoddart GL, Torrance GW. Methods for the Economic Evaluation of Health Care Programmes. Oxford university press; 2015.
Brouwer WRF, Koopmanschap M. Costing in economic evaluations. In: Drummond M, McGuire A, eds. Economic Evaluation in Health Care. Merging Theory with Practice. Oxford. Oxford University Press; 2001:68-93.
German Institute for Quality and Efficiency in Health Care. Working Paper Cost Estimation - Version 1.0-19/11/2009. 2009; https://tools.ispor.org/PEguidelines/source/Germany_WorkPaperCostEst.pdf. Accessed April 06, 2022.
Bundesinstitut für Arzneimittel und Medizinprodukte. OPS Version 2022: Operationen- und Prozedurenschlüssel, Version 2022. 2022; https://www.dimdi.de/static/de/klassifikationen/ops/kode-suche/opshtml2022/. Accessed March 28, 2022.
Busse R, Schreyögg J. Management im Gesundheitswesen - eine Einführung in Gebiet und Buch. In: Gericke C, ed. Management im Gesundheitswesen. Springer; 2006:1-9.
National Association of Statutory Health Insurance Funds. Landesbasisfallwerte. https://www.gkv-spitzenverband.de/krankenversicherung/krankenhaeuser/budgetverhandlungen/landesbasisfallwerte/landesbasisfallwerte.jsp. Accessed December 23, 2022.
von der Schulenburg J-MG, Greiner W, Jost F, et al. Deutsche Empfehlungen zur gesundheitsökonomischen Evaluation-dritte und aktualisierte Fassung des Hannoveraner Konsens. Gesundheitsökonomie & Qualitätsmanagement. 2007;12(5):285-290.
Verband der Universitätsklinika Deutschlands. Politikbrief - Argumente und Lösungen der deutschen Uniklinika. 2020; https://www.uniklinika.de/fileadmin/user_upload/VUD_PB_02_2020_final.pdf. Accessed May 03, 2022.
Arango C. Lessons learned from the coronavirus health crisis in Madrid, Spain: how COVID-19 has changed our lives in the last 2 weeks. Biol Psychiatry. 2020;88(7):e33-e34.
Ritter M, Ott DVM, Paul F, Haynes JD, Ritter K. COVID-19: a simple statistical model for predicting intensive care unit load in exponential phases of the disease. Sci Rep. 2021;11(1):5018.
Ruhnke M, Cornely OA, Schmidt-Hieber M, et al. Treatment of invasive fungal diseases in cancer patients-revised 2019 recommendations of the infectious diseases working party (AGIHO) of the German Society of Hematology and Oncology (DGHO). Mycoses. 2020;63(7):653-682.
Sun HY, Singh N. Mucormycosis: its contemporary face and management strategies. Lancet Infect Dis. 2011;11(4):301-311.
Chamilos G, Lewis RE, Kontoyiannis DP. Delaying amphotericin B-based frontline therapy significantly increases mortality among patients with hematologic malignancy who have zygomycosis. Clin Infect Dis. 2008;47(4):503-509.
Bagshaw E, Enoch DA, Blackney M, Posthumus J, Kuessner D. Economic impact of treating invasive mold disease with isavuconazole compared with liposomal amphotericin B in the UK. Future Microbiol. 2018;13(11):1283-1293.
Kron F, Wingen-Heimann S, Jeck J, Lazzaro C, Cornely O, Thielscher C. Principal-agent theory-based cost and reimbursement structures of isavuconazole treatment in German hospitals. Mycoses. 2020;64:86-94.
German Institute for Hospital Reimbursement. Hilfestellung für die Kalkulation von Zusatzentgelten gem. § 6 Abs. 1 KHEntgG und Zusatzentgelten für neue Untersuchungs- und Behandlungsmethoden gem. § 6 Abs. 2 KHEntgG. 2005; https://www.g-drg.de/content/download/1194/7822/version/1/file/Kalkulationsempfehlung_11112005.pdf. Accessed April 06, 2022.
Jeck J, Wingen-Heimann SM, Thielscher C, et al. Reimbursement of innovative pharmaceuticals in English and Spanish hospitals-the example of isavuconazole. Mycoses. 2021;64(10):1213-1222.