407. Changes in the utilization patterns of antifungal agents, medical cost and clinical outcomes of candidemia by health care benefit expansion to include newer antifungal agents
Session: Poster Abstract Session: Fungal Disease: Management and Outcomes
Thursday, October 4, 2018
Room: S Poster Hall
Background: Candidemia is a major life-threatening fungal infection in hospitalized patients worldwide. In 2014, South Korea’s national health insurance expanded its coverage for newer antifungal agents such as echinocandins. This study investigated the effects of change in insurance coverage on the prescription patterns of antifungals, medical costs, and treatment outcomes of candidemia.

Methods: A retrospective cohort study was conducted for all hospitalized patients with candidemia at three tertiary care hospitals in South Korea from January 2012 to December 2015. The utilization of antifungal agents, medical cost, and treatment outcomes before and after the health care benefit expansion were compared and the factors associated with 28-day mortality during the study period were analyzed.

Results: A total of 769 candidemia patients were identified during the study period: from 2012 to 2015, there were 196, 199, 201, and 173 patients, respectively. The incidence of candidemia did not change during the study period (P = 0.253). The proportion of echinocandins as the initial antifungal agent and direct medical costs for candidemia significantly increased since the change in insurance coverage (P < 0.001). There was no significant difference in 28-day mortality of candidemia before and after the health care benefit expansion (P = 0.067). On multivariable analysis, independent factors associated with the 28-day mortality were Charlson comorbidity score (odds ratio [95% confidence interval]: 1.171 [1.080-1.269]), SOFA score (1.258 [1.185-1.335]) and initial treatment with amphotericin B (versus: fluconazole (0.624 [0.428-0.912]) and caspofungin (0.517 [0.269-0.993]).

Conclusion: Although the utilization of newer antifungal agents and medical cost for candidemia has significantly increased since the health care benefit expansion, to include newer antifungal agents, the policy change does not seem to change the mortality rate of candidemia in South Korea.

Heun Choi, MD1, Woonji Lee, MD1, Hye Seong, MD2, Jung Ho Kim, MD1, Jin Young Ahn, MD1, Su Jin Jeong, MD/PhD3, Nam Su Ku, MD, PhD1, Young Keun Kim, MD, PhD4, Joon Sup Yeom, MD, PhD3, Hyo Youl Kim, MD, PhD5, Young Goo Song, MD, PhD6, June Myung Kim, MD, PhD3 and Jun Yong Choi, MD, PhD3, (1)Department of Internal Medicine and AIDS Research Institute, Yonsei University College of Medicine, Seoul, Korea, Republic of (South), (2)Dpartment of Internal Medicine and AIDS Research Institute, Yonsei University College of Medicine, Seoul, Korea, Republic of (South), (3)Division of Infectious Disease, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea, Republic of (South), (4)Dept. of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea, Republic of (South), (5)Division of Infectious Diseases, Yonsei University Wonju College of Medicine, Wonju, Korea, Republic of (South), (6)Division of Infectious Diseases, Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea, Republic of (South)

Disclosures:

H. Choi, None

W. Lee, None

H. Seong, None

J. H. Kim, None

J. Y. Ahn, None

S. J. Jeong, None

N. S. Ku, None

Y. K. Kim, None

J. S. Yeom, None

H. Y. Kim, None

Y. G. Song, None

J. M. Kim, None

J. Y. Choi, None

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