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Cost Analysis of Fluconazole Prophylaxis for Prevention of Neonatal Invasive Candidiasis
Jonathan R Swanson1, Jeff Vergales, David A Kaufman
1From the *Division of Neonatology, Department of Pediatrics, and †Division of Cardiology, Department of Pediatrics, University of Virginia, Charlottesville, VA.
Insights
Fluconazole prophylaxis (FP) in premature infants is cost-beneficial, preventing invasive candidiasis (IC). The cost-benefit is maintained as long as the invasive candidiasis rate remains below 2.8%.
Area of Science:
- Neonatal Medicine
- Pharmacoeconomics
- Infectious Disease Prevention
Background:
- Invasive candidiasis (IC) in neonates incurs significant healthcare costs.
- Fluconazole prophylaxis (FP) is established to reduce IC rates in premature infants.
- Cost-benefit analysis of FP can further justify its targeted use in high-risk neonates.
Purpose of the Study:
- To determine the threshold rate of invasive candidiasis (IC) at which fluconazole prophylaxis (FP) becomes cost-beneficial in premature infants.
- To evaluate the economic impact of FP in preventing IC in neonatal intensive care units.
Main Methods:
- A decision tree cost-analysis model was employed, comparing FP costs with IC-associated costs.
- Literature review of PubMed for studies on intravenous FP and IC rates in very low birth weight neonates.
- Sensitivity analysis and Monte Carlo simulation were used to assess cost-effectiveness across various IC rates and patient populations.
Main Results:
- The average cost per patient due to IC was significantly lower with FP ($785) compared to no FP ($2617).
- FP remains cost-beneficial if the IC rate is below 2.8%.
- Targeting infants under 1000g with FP could result in an estimated $50.3 million annual cost savings in the US.
Conclusions:
- Fluconazole prophylaxis offers a significant cost advantage for the youngest premature infants across a wide range of invasive candidiasis rates.
- A threshold IC rate of 2.8% can guide healthcare providers in deciding the cost-effectiveness of FP for individual high-risk neonatal intensive care unit patients.
Background:
Fluconazole prophylaxis (FP) in premature infants is well studied and has been shown to decrease invasive candidiasis (ICs). IC in neonates has significant financial costs; determining the cost-benefit of FP may provide additional justification for targeting high-risk neonates. We aimed to determine the IC rate in premature infants at which FP is cost-beneficial.
Methods:
A decision tree cost-analysis model using cost of FP related to costs associated with IC was used. We searched PubMed for all papers that used intravenous FP and reported rates of IC in very low birth weight neonates. Average IC rates in those who received FP (2.0%; range, 0-6.1%) and in those who did not receive FP (9.2%; range, 0-20.5%) were used. Incremental hospital costs because of IC and for FP were retrieved from the literature. Sensitivity analysis was performed to determine the incremental cost of FP across the range of published IC rates.
Results:
The average cost per patient attributed to IC in patients receiving FP was $785 versus $2617 in those not receiving FP. Sensitivity analysis demonstrates the rate of IC would need to be <2.8% for FP to lose its cost-benefit. In Monte Carlo simulation, targeting infants <1000 g would lead to $50,304,333 in cost savings per year in the United States.
Conclusions:
FP provides a cost-advantage across most IC rates seen in the youngest premature infants. Using a rate of 2.8% for their individual high-risk neonatal intensive care unit patients, providers can determine if FP is cost-beneficial in determining for whom to provide IC prophylaxis.
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