Cost Effectiveness of Candida Polymerase Chain Reaction Detection and Empirical Antifungal Treatment among Patients with Suspected Fungal Peritonitis in the Intensive Care Unit

Abstract

Detection by PCR of all Candida species and of most fluconazole-resistant Candida species could improve the cost-effectiveness of fluconazole and echinocandin given to non-neutropenic patients with suspected peritoneal candidiasis in ICUs.

Fungal peritonitis in peritoneal dialysis: 5-year review from a North China center

“…As the fluconazole-resistant Candida spp. tend to increase, the updated Infectious Diseases Society of America (IDSA) guideline strongly recommends an echinocandin as initial therapy for intra-abdominal candidiasis, yet cost-effectiveness considerations may hamper the widespread of such practice in developing countries [17,34]. In our study, fluconazole was used in most cases for initial therapy and later antifungal regimen, whereas echinocandins (caspofungin) was only used in two cases.…”

Spontaneous Fungal Peritonitis

“…Some studies support the use of polymerase chain reaction (PCR) for (1→3)-β-D-glucan and galactomannan testing for early diagnosis of fungal peritonitis. Wherever available, PCR is encouraged because it is a cost-effective alternative that delivers rapid and reliable results, leading to early antifungal therapy (4).…”

A New Age in Molecular Diagnostics for Invasive Fungal Disease: Are We Ready?

“…The cost-effectiveness of a Candida PCR test was examined in terms of the use of fluconazole versus the more expensive echinocandin drugs as empiric treatment of Candida peritonitis, when traditionally fluconazole resistant species (e.g., C. glabrata, C. krusei) could be quickly detected by the PCR. This study found that use of fluconazole empirical treatment with PCR to detect the fluconazole resistant species (changing over to an echinocandin) is more cost effective than using fluconazole empirical treatment without PCR (Pagès et al, 2017). Furthermore, a recent analysis of the cost-effectiveness of T2Candida determined it was less costly than blood culturedirected and empiric echinocandin therapy.…”