Collins Curtis D, Eschenauer Gregory A, Salo Susan L, Newton Duane W
Department of Pharmacy Services, University of Michigan Health System, UHB2D301 University Hospital, Ann Arbor, MI 48109-0008, USA.
J Clin Microbiol. 2007 Jun;45(6):1884-8. doi: 10.1128/JCM.00192-07. Epub 2007 Apr 4.
This cost minimization analysis investigated the financial impact of the treatment of fungemias due to Candida glabrata from a hospital perspective using three competing alternatives: (i) performing in-house susceptibility testing on all C. glabrata isolates and changing patients to less expensive fluconazole therapy for isolates that test susceptible; (ii) susceptibility testing at outside laboratories with delayed deescalation to fluconazole if isolates test susceptible; and (iii) no routine susceptibility testing with full echinocandin treatment course. Sensitivity analyses and Monte Carlo simulation enhanced the robustness of the model through variation of all assumptions and costs. In the base case, the use of in-house testing displayed a cost advantage over the options of send-out testing and no susceptibility testing ($2,226 versus $2,410 versus $3,136, respectively). Sensitivity analyses determined that the cost of echinocandin therapy and the turnaround time for send-out testing had the potential to impact the base case model. The decision model indicated that in-house susceptibility testing of C. glabrata isolates should result in lower overall treatment costs in patients with documented C. glabrata fungemias.
这项成本最小化分析从医院角度，使用三种相互竞争的方案，研究了光滑念珠菌引起的真菌血症治疗的财务影响：（i）对所有光滑念珠菌分离株进行内部药敏试验，并将对药敏试验敏感的分离株患者改用成本较低的氟康唑治疗；（ii）在外部实验室进行药敏试验，如果分离株药敏试验敏感，则延迟降阶梯至氟康唑治疗；（iii）不进行常规药敏试验，采用全程棘白菌素治疗。敏感性分析和蒙特卡洛模拟通过改变所有假设和成本提高了模型的稳健性。在基础案例中，与送检检测和不进行药敏试验的方案相比，使用内部检测显示出成本优势（分别为2226美元、2410美元和3136美元）。敏感性分析确定，棘白菌素治疗成本和送检检测周转时间有可能影响基础案例模型。决策模型表明，对光滑念珠菌分离株进行内部药敏试验应能降低有记录的光滑念珠菌真菌血症患者的总体治疗成本。
