PIN38 Real Life Study of Antifungal Treatment in Greek ICUs: Therapeutic Strategy and Hospital Resource Utilization – Estimator Study

Abstract

The ESTIMATOR study aims to provide information on clinical and economic outcomes associated with the management of fungal infections across intensive care units (ICUs) in Greece. ESTIMATOR was a non-interventional prospective cohort study conducted in 14 ICUs in Greece. Adult patients initiating therapy with a systemic antifungal agent between July 2011 and February 2012 were included. Information on predisposing factors, management and therapeutic strategies, clinical outcomes and length of ICU stay (LOICUS) were recorded until end of therapy or death. A total of 155 eligible patients were recruited. 68% of patients presented at least 5 predisposing factors for fungal infection at antifungal treatment (AT) onset, while the mean APACHE score was 22.4 (s.d. 5.9). Median time until AT initiation was 6 days after ICU admission, while the median LOICUS was 31 days. 49.7% of patients received treatment with an empiric strategy while prophylaxis, pre-emptive and definitive strategies where used at 6.4%, 20.0% and 23.9% of the study population respectively. Echinocandins (57.3%), Fluconazole (20.0%) and Itraconazole (12.9%) were the most utilized therapies in the study. The overall treatment success and mortality rates were 43.9% and 49.7% respectively. Variations in death and response rates were observed when adjusted to the treatment strategy and the class of drug used. The mean total cost per patient treated was estimated at 22,012 Euros. Average LOICUS accounts for the 80.8% of total direct costs, while antifungal treatment, tests and investigations account for the remaining 19.2%. Limited efficacy of first line antifungal agent is associated with an increase in economic costs of 74%. Treating patients for fungal infections imposes a high economic burden to hospitals. Significant cost drivers are prolonged LOICUS and treatment failure. Treatment options that result in LOICUS reduction and increased first line efficacy have the potential to reduce hospital cost.