614. Hospital Database Analysis of Hematologic Malignancy and Bone Marrow Transplant/Stem Cell Transplant (BMT/SCT) Patients with Invasive Aspergillosis (IA)
Session: Abstracts: Mycology
Friday, October 22, 2010
Background:

Our objective is to describe the clinical and economic impact of invasive aspergillosis (IA) in hospitalized patients with hematologic (heme) malignancy or BMT/SCT, including impact of initial antifungal on mortality, length of stay (LOS), and total costs.

Methods:

A retrospective US hospital database analysis (2005-2008) of >500 hospitals was conducted. Adult patients were included with aspergillosis (ICD-9 117.3x) and heme malignancy (200–208) or BMT/SCT (41), and receiving an Aspergillus-specific antifungal. Outcomes and antifungal treatment patterns were examined. Regression analyses were conducted to determine the impact of initial antifungal on mortality, length of stay (LOS) and total costs controlling for patient demographics, hospital characteristics, co-morbidities, and illness severity.

Results:

From 6,424 aspergillosis patients in the database, 627 heme malignancy/BMT/SCT patients with IA were identified with mean age 58 years, 60% male, and 73% Caucasian. The most commonly used antifungals were voriconazole (vori) (83% received vori at least once), caspofungin (caspo) (44%), or an amphotericin B (AMB) preparation including liposomal formulations (28%). In those receiving dual agents, vori plus caspo was the most frequent (36%), and combinations were used initially in 27%. Average length of antifungal treatment was 22 days. Overall hospital mortality was 29%. In multivariate analysis controlling for patient/hospital characteristics, initial AMB monotherapy was associated with increased mortality (OR 2.4 vs initial vori monotherapy, p=0.029; OR 1.9 vs caspo monotherapy, p=0.146). For resource utilization, average LOS was 28 days, with 40%, 25%, and 16% requiring ICU days, mechanical ventilation, and rehospitalization, respectively. Total hospital costs averaged $80,100 per patient. Controlling for mortality and patient/hospital characteristics, greater total costs were associated with initial echinocandin monotherapy (+25% vs initial vori monotherapy; p=0.023).

Conclusion:

Heme malignancy/BMT/SCT patients with IA represent a significant economic burden to hospitals and payers. Our findings suggest that initial antifungal for IA impacts clinical and economic outcomes in this population.


Subject Category: N. Hospital-acquired and surgical infections, infection control, and health outcomes including general public health and health services research

Speakers:
Jennifer Stephens, PharmD , Pharmerit North America LLC, Bethesda, MD
Xin Gao, PhD , Pharmerit North America LLC, Bethesda, MD
Xiang Ji, MS , Pharmerit North America LLC, Bethesda, MD
John Baddley, MD , Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, AL
Haran Schlamm, MD , Pfizer Inc, New York, NY
Miriam Tarallo, MS , Pfizer Inc, New York, NY

Disclosures:

J. Stephens, Yes
Pfizer: Research Contractor,

X. Gao, Yes
Pfizer: Research Contractor,

X. Ji, Yes
Pfizer: Research Contractor,

J. Baddley, Yes
Pfizer: Consultant and Grant Investigator,

H. Schlamm, Yes
Pfizer: Employee and Shareholder,

M. Tarallo, Yes
Pfizer: Employee and Shareholder, Salary

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