Changes in the utilization patterns of antifungal agents, medical cost and clinical outcomes of candidemia from the health-care benefit expansion to include newer antifungal agents

Heun Choi, Jung Ho Kim, Hye Seong, Woonji Lee, Wooyong Jeong, Jin Young Ahn, Su Jin Jeong, Nam Su Ku, Joon Sup Yeom, YoungKeun Kim, Hyo Youl Kim, Young Goo Song, June Myung Kim, JunYong Choi

Research output: Contribution to journalArticle

Abstract

Objectives: In 2014, South Korea expanded its national health insurance coverage to include newer antifungal agents, such as echinocandins. This study aimed to investigate the effects of policy change on the prescription patterns of antifungals, medical costs and clinical outcomes of candidemia. Methods: This retrospective cohort enrolled hospitalized patients with candidemia at three tertiary care hospitals in South Korea from January 2012 to December 2015. The utilization of antifungal agents, medical costs, length of hospital stay (LOS), and mortality before and after the health-care benefit expansion were compared, and the factors associated with all-cause 28-day mortality during the study period were analyzed. Results: A total of 769 candidemia cases were identified. The incidence of candidemia did not significantly vary during the study period (P = 0.253). The proportion of echinocandins, as the initial antifungal agent, and medical costs associated with candidemia significantly increased since the change in insurance coverage (P < 0.001). There was no significant difference in LOS and mortality associated with candidemia before and after the health-care benefit expansion (P = 0.696 and 0.931, respectively). Multivariate logistic regression analysis showed that initial treatment with caspofungin was associated with decreased mortality (adjusted odds ratio: 0.784; 95% confidence interval: 0.681–0.902; reference: fluconazole). Conclusions: Although the utilization of newer antifungal agents and medical cost for candidemia has significantly increased since the health-care benefit expansion, there has been no change in the outcome of candidemia. However, the further increased use of newer antifungals may improve the outcome of candidemia in this country.

Original languageEnglish
Pages (from-to)49-55
Number of pages7
JournalInternational Journal of Infectious Diseases
Volume83
DOIs
Publication statusPublished - 2019 Jun 1

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Candidemia
Antifungal Agents
Insurance Benefits
Delivery of Health Care
Costs and Cost Analysis
Length of Stay
Echinocandins
Republic of Korea
Insurance Coverage
Hospital Mortality
caspofungin
Mortality
Fluconazole
National Health Programs
Tertiary Healthcare
Tertiary Care Centers
Prescriptions
Logistic Models
Odds Ratio
Regression Analysis

All Science Journal Classification (ASJC) codes

  • Microbiology (medical)
  • Infectious Diseases

Cite this

Choi, Heun ; Kim, Jung Ho ; Seong, Hye ; Lee, Woonji ; Jeong, Wooyong ; Ahn, Jin Young ; Jeong, Su Jin ; Ku, Nam Su ; Yeom, Joon Sup ; Kim, YoungKeun ; Kim, Hyo Youl ; Song, Young Goo ; Kim, June Myung ; Choi, JunYong. / Changes in the utilization patterns of antifungal agents, medical cost and clinical outcomes of candidemia from the health-care benefit expansion to include newer antifungal agents. In: International Journal of Infectious Diseases. 2019 ; Vol. 83. pp. 49-55.
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abstract = "Objectives: In 2014, South Korea expanded its national health insurance coverage to include newer antifungal agents, such as echinocandins. This study aimed to investigate the effects of policy change on the prescription patterns of antifungals, medical costs and clinical outcomes of candidemia. Methods: This retrospective cohort enrolled hospitalized patients with candidemia at three tertiary care hospitals in South Korea from January 2012 to December 2015. The utilization of antifungal agents, medical costs, length of hospital stay (LOS), and mortality before and after the health-care benefit expansion were compared, and the factors associated with all-cause 28-day mortality during the study period were analyzed. Results: A total of 769 candidemia cases were identified. The incidence of candidemia did not significantly vary during the study period (P = 0.253). The proportion of echinocandins, as the initial antifungal agent, and medical costs associated with candidemia significantly increased since the change in insurance coverage (P < 0.001). There was no significant difference in LOS and mortality associated with candidemia before and after the health-care benefit expansion (P = 0.696 and 0.931, respectively). Multivariate logistic regression analysis showed that initial treatment with caspofungin was associated with decreased mortality (adjusted odds ratio: 0.784; 95{\%} confidence interval: 0.681–0.902; reference: fluconazole). Conclusions: Although the utilization of newer antifungal agents and medical cost for candidemia has significantly increased since the health-care benefit expansion, there has been no change in the outcome of candidemia. However, the further increased use of newer antifungals may improve the outcome of candidemia in this country.",
author = "Heun Choi and Kim, {Jung Ho} and Hye Seong and Woonji Lee and Wooyong Jeong and Ahn, {Jin Young} and Jeong, {Su Jin} and Ku, {Nam Su} and Yeom, {Joon Sup} and YoungKeun Kim and Kim, {Hyo Youl} and Song, {Young Goo} and Kim, {June Myung} and JunYong Choi",
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Changes in the utilization patterns of antifungal agents, medical cost and clinical outcomes of candidemia from the health-care benefit expansion to include newer antifungal agents. / Choi, Heun; Kim, Jung Ho; Seong, Hye; Lee, Woonji; Jeong, Wooyong; Ahn, Jin Young; Jeong, Su Jin; Ku, Nam Su; Yeom, Joon Sup; Kim, YoungKeun; Kim, Hyo Youl; Song, Young Goo; Kim, June Myung; Choi, JunYong.

In: International Journal of Infectious Diseases, Vol. 83, 01.06.2019, p. 49-55.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Changes in the utilization patterns of antifungal agents, medical cost and clinical outcomes of candidemia from the health-care benefit expansion to include newer antifungal agents

AU - Choi, Heun

AU - Kim, Jung Ho

AU - Seong, Hye

AU - Lee, Woonji

AU - Jeong, Wooyong

AU - Ahn, Jin Young

AU - Jeong, Su Jin

AU - Ku, Nam Su

AU - Yeom, Joon Sup

AU - Kim, YoungKeun

AU - Kim, Hyo Youl

AU - Song, Young Goo

AU - Kim, June Myung

AU - Choi, JunYong

PY - 2019/6/1

Y1 - 2019/6/1

N2 - Objectives: In 2014, South Korea expanded its national health insurance coverage to include newer antifungal agents, such as echinocandins. This study aimed to investigate the effects of policy change on the prescription patterns of antifungals, medical costs and clinical outcomes of candidemia. Methods: This retrospective cohort enrolled hospitalized patients with candidemia at three tertiary care hospitals in South Korea from January 2012 to December 2015. The utilization of antifungal agents, medical costs, length of hospital stay (LOS), and mortality before and after the health-care benefit expansion were compared, and the factors associated with all-cause 28-day mortality during the study period were analyzed. Results: A total of 769 candidemia cases were identified. The incidence of candidemia did not significantly vary during the study period (P = 0.253). The proportion of echinocandins, as the initial antifungal agent, and medical costs associated with candidemia significantly increased since the change in insurance coverage (P < 0.001). There was no significant difference in LOS and mortality associated with candidemia before and after the health-care benefit expansion (P = 0.696 and 0.931, respectively). Multivariate logistic regression analysis showed that initial treatment with caspofungin was associated with decreased mortality (adjusted odds ratio: 0.784; 95% confidence interval: 0.681–0.902; reference: fluconazole). Conclusions: Although the utilization of newer antifungal agents and medical cost for candidemia has significantly increased since the health-care benefit expansion, there has been no change in the outcome of candidemia. However, the further increased use of newer antifungals may improve the outcome of candidemia in this country.

AB - Objectives: In 2014, South Korea expanded its national health insurance coverage to include newer antifungal agents, such as echinocandins. This study aimed to investigate the effects of policy change on the prescription patterns of antifungals, medical costs and clinical outcomes of candidemia. Methods: This retrospective cohort enrolled hospitalized patients with candidemia at three tertiary care hospitals in South Korea from January 2012 to December 2015. The utilization of antifungal agents, medical costs, length of hospital stay (LOS), and mortality before and after the health-care benefit expansion were compared, and the factors associated with all-cause 28-day mortality during the study period were analyzed. Results: A total of 769 candidemia cases were identified. The incidence of candidemia did not significantly vary during the study period (P = 0.253). The proportion of echinocandins, as the initial antifungal agent, and medical costs associated with candidemia significantly increased since the change in insurance coverage (P < 0.001). There was no significant difference in LOS and mortality associated with candidemia before and after the health-care benefit expansion (P = 0.696 and 0.931, respectively). Multivariate logistic regression analysis showed that initial treatment with caspofungin was associated with decreased mortality (adjusted odds ratio: 0.784; 95% confidence interval: 0.681–0.902; reference: fluconazole). Conclusions: Although the utilization of newer antifungal agents and medical cost for candidemia has significantly increased since the health-care benefit expansion, there has been no change in the outcome of candidemia. However, the further increased use of newer antifungals may improve the outcome of candidemia in this country.

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