123. Clinical and Economic Burden of Invasive Mucormycosis: A Multicenter Cost-of-Illness Analysis of Patients Treated in German Tertiary Care Hospitals between 2005 – 2016
Session: Oral Abstract Session: Epidemiology and Outcomes in Mycology
Thursday, October 27, 2016: 11:15 AM
Room: 288-290
Background: Incidence rates of invasive mucormycosis (IM) markedly increased during the past decade. However, data concerning the clinical and economic burden of IM are scarce.

Methods: We performed a retrospective cost-of-illness analysis of cases with IM extracted from FungiScope – Global Registry for Emerging Fungal Infections. To analyze direct inpatient treatment costs and length of stay, a further registry was set up on www.ClinicalSurveys.net and physicians were invited to provide additional information concerning the most important cost drivers in treatment of IM. This health economic evaluation was carried out based on national guidelines and results were compared to patients with similar underlying diseases based on the German Diagnosis Related Groups (G-DRG) system who did not develop an IM.

Results: To date, 40 patients with probable/proven IM from three German tertiary care centers were included into analysis. Most patients were male (n= 27, 67.5%) and median age was 58 years (range: 11 – 88 years). The most common risk factors were hematological disorders (n= 35, 87.5%), chemotherapy (n= 27, 67.5%), and allogeneic stem cell transplantation (n= 14, 35%). Lungs were identified as site of infection in 32 patients (80%) and 24 patients (60%) received antifungal prophylaxis prior to diagnosis of IM. Mean overall length of stay of patients with IM were 57.0 days (95% CI: 47.4 – 66.7 days). Analysis of cost factors identified the primary cost drivers as antifungal treatment due to IM €20,836 (95% CI: €11,314 - €30,358) and treatment on specialized care units (intermediate care unit, bone marrow transplant unit, intensive care unit) €18,209 (95% CI: €10,453 - €25,965), resulting in mean overall direct treatment costs of €52,820 (95% CI: €36,129 - €69,511). Compared to patients coded with the same G-DRG but without IM, patients with IM were treated in hospital for 26.3 (95% CI: 18.3 – 34.3 days; P< 0.001) additional days, resulting in mean additional costs of €33,033 (95% CI: €19,000 - €47,066; P< 0.001). Eighteen patients (45%) died during hospitalization.

Conclusion: Our comprehensive cost-of-illness analysis demonstrates the clinical and economic burden of IM. Most important cost drivers were antifungal drug acquisition and treatment on specialized care units. Innovative treatment strategies are needed to improve patient outcome and reduce treatment costs.

Sebastian Marcel Heimann, Dr.1, Maria Vehreschild, MD2, Oliver Cornely, MD, FACP, FIDSA, FAAM1, Werner Heinz, MD3, Johanna Kessel, MD4, Danila Seidel, PhD2 and Joerg Janne Vehreschild, PD Dr. med.2, (1)Department I of Internal Medicine, University Hospital of Cologne, Cologne, Germany, (2)University Hospital of Cologne, Cologne, Germany, (3)Department for Internal Medicine II, University Medical Center, Würzburg, Germany, (4)Department II of Internal Medicine, Infectiology, University Hospital of Frankfurt, Frankfurt/Main, Germany

Disclosures:

S. M. Heimann, Astellas: Investigator and Speaker's Bureau , Research grant , Speaker honorarium and Travel grants
MSD/Merck: Investigator and Speaker's Bureau , Research grant , Speaker honorarium and Travel grants
Basilea: Investigator , Research grant
Gilead: Investigator , Research grant
Pfizer: Investigator , Travel grant

M. Vehreschild, MSD/Merck: Consultant and Speaker's Bureau , Consulting fee and Speaker honorarium
Gilead Sciences: Speaker's Bureau , Speaker honorarium
Astellas Pharma: Consultant , Research Contractor and Speaker's Bureau , Consulting fee , Research support and Speaker honorarium

O. Cornely, Astellas Pharma: Consultant , Grant Investigator and Speaker's Bureau , Consulting fee , Grant recipient and Speaker honorarium
Basilea: Consultant , Grant Investigator and Speaker's Bureau , Consulting fee , Grant recipient and Speaker honorarium
Gilead Sciences: Consultant , Grant Investigator and Speaker's Bureau , Consulting fee , Grant recipient and Speaker honorarium
Merck/MSD: Consultant , Grant Investigator and Speaker's Bureau , Consulting fee , Grant recipient and Speaker honorarium
Pfizer: Consultant and Grant Investigator , Consulting fee , Grant recipient and Speaker honorarium

W. Heinz, MSD/Merck: Investigator and Speaker's Bureau , Research grant and Travel grants
Pfizer: Investigator and Speaker's Bureau , Research grant and Travel grants
Alexion: Investigator and Speaker's Bureau , Travel grants
Astellas: Investigator and Speaker's Bureau , Travel grants
Basilea: Speaker's Bureau , Speaker honorarium
Bristol-Myers Squibb: Speaker's Bureau , Speaker honorarium
Chugai Pharma: Speaker's Bureau , Speaker honorarium
Gilead: Speaker's Bureau , Speaker honorarium
Janssen: Speaker's Bureau , Speaker honorarium
Novartis: Investigator , Travel grants

J. Kessel, MSD/Merck: Speaker's Bureau , Speaker honorarium
Gilead: Speaker's Bureau , Speaker honorarium and Travel grants
Pfizer: Speaker's Bureau , Speaker honorarium
Astellas: Investigator , Travel grants

D. Seidel, Astellas: Investigator , Travel grants
Basilea: Investigator , Travel grants

J. J. Vehreschild, Astellas: Speaker's Bureau , Research grant and Speaker honorarium
Gilead: Speaker's Bureau , Research grant and Speaker honorarium
Infectopharm: Investigator , Research grant
Merck/MSD: Speaker's Bureau , Research grant and Speaker honorarium
Pfizer: Speaker's Bureau , Research grant and Speaker honorarium

Findings in the abstracts are embargoed until 12:01 a.m. CDT, Wednesday Oct. 26th with the exception of research findings presented at the IDWeek press conferences.