Methods: Using adult and pediatric AF data for acute care hospitals from the Truven Health MarketScan® Hospital Drug Database (HDD) during 2006–2012, we estimated days of therapy (DOT)/10,000 patient days (PDs) by AF drug type, year, and facility characteristics. We used Centers for Medicare and Medicaid Services Healthcare Cost Report Information System to generate estimated weights to apply to the HDD data to create national estimates of AF use. A multivariate GEE model to account for inter-hospital covariance was used to assess trends over time.
Results: During 2006–2012, 300–383 hospitals/year, representing 166 million PDs, contributed AF data to the HDD. The overall estimated DOT for any AF was 350 DOT/10,000 PDs; azoles accounted for 80% of all AF use (285/10,000), followed by echinocandins (50/10,000) and polyenes (11/10,000). Multivariable trend analysis showed a statistically significant decrease in DOT for azoles and polyenes of 21% and 47%, respectively (p<0.001), with a significant increase of 23% in echinocandins for 2009–2010 compared to 2006. Within azoles, fluconazole use declined by 22% (p<0.001), voriconazole use remained stable, and posaconazole use more than doubled (p=0.007). Hospitals in the Southeast and Southwest Central and Mountain regions had the highest AF DOT, and hospitals in the highest quartile for case mix index (a composite measure of patient disease severity) had a 10% higher DOT compared to hospitals in the lowest quartile (p<0.001).
Conclusion:Azoles comprised the largest proportion of AF DOT in hospitals, but azole use decreased during 2006–2012. Adoption of 2016 IDSA guidelines on candidemia treatment may lead to further declines in fluconazole use and increases in echinocandin use; AF use trends should continue to be monitored. Variation of AF use by region deserves further exploration to identify opportunities for AF stewardship.
S. Lockhart, None
J. Jernigan, None
B. Jackson, None