Current Usage and Prospect of New Antifungal agents in Korea

Kim, Sang Il; Kang, Moon Won

doi:10.3947/ic.2010.42.4.209

Cited by 6 publications

(5 citation statements)

References 18 publications

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“…We found that as members of the nonalbicans Candida species, the frequency of C. glabrata and C. krusei, known to be resistant to azoles, has increased from 11.3 to 16.3% and 0.5 to 1.7%, respectively, compared to previous studies (Jung et al, 2010;Lee et al, 2007). Although caspofungin was approved by the Korean Food and Drug Administration in 2001, there were cost-related barriers to its prescription because the total drug costs could not be covered by the national health insurance before the policy change (Kim and Kang, 2010). After the change in national health insurance coverage for newer antifungal agents, the patient's out-of-pocket share was reduced to 20% of the overall cost.…”

Section: Discussionmentioning

confidence: 99%

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

Kim

Seong

et al. 2019

International Journal of Infectious Diseases

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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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Section: Discussionmentioning

confidence: 99%

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

Kim

Seong

et al. 2019

International Journal of Infectious Diseases

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“…The number of units consumed by each patient was multiplied by the cost per unit of each resource to estimate the direct costs for each patient. Since the four hospitals in the present study are rated as superior general hospitals in Korea, additional 30% of costs are charged for every resource provided (total costs ϭ the number of units consumed ϫ the unit cost ϫ (10), the use of these drugs as first-line agents in the treatment of invasive candidiasis or candidemia was limited due to their higher cost. Fluconazole or amphotericin B deoxycholate is admitted as first-line agents against Candida infection in Korea, and echinocandins admitted in the setting of treatment failure or toxicities of which criteria are defined by HIRA (health insurance review and assessment).…”

Section: Methodsmentioning

confidence: 99%

“…Although the 2009 guidelines for candidemia treatment by the Infectious Diseases Society of America recommend echinocandins as the first-line antifungal agents in the setting of neutropenia or moderate to severe illness (12), these drugs are not widely used worldwide as first-line agents due to their relatively high costs, especially in resource-limited countries (6,10). Fluconazole is still the most widely used drug, and amphotericin B deoxycholate is also frequently used for broader coverage of candidemia.…”

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confidence: 99%

Impact of First-Line Antifungal Agents on the Outcomes and Costs of Candidemia

Peck

Joo

et al. 2012

Antimicrob Agents Chemother

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dCandida species are the leading causes of invasive fungal infection among hospitalized patients and are responsible for major economic burdens. The goals of this study were to estimate the costs directly associated with the treatment of candidemia and factors associated with increased costs, as well as the impact of first-line antifungal agents on the outcomes and costs. A retrospective study was conducted in a sample of 199 patients from four university-affiliated tertiary care hospitals in Korea over 1 year. Only costs attributable to the treatment of candidemia were estimated by reviewing resource utilization during treatment. Risk factors for increased costs, treatment outcome, and hospital length of stay (LOS) were analyzed. Approximately 65% of the patients were treated with fluconazole, and 28% were treated with conventional amphotericin B. The overall treatment success rate was 52.8%, and the 30-day mortality rate was 47.9%. Hematologic malignancy, need for mechanical ventilation, and treatment failure of first-line antifungal agents were independent risk factors for mortality. The mean total cost for the treatment of candidemia was $4,743 per patient. Intensive care unit stay at candidemia onset and antifungal switch to second-line agents were independent risk factors for increased costs. The LOS was also significantly longer in patients who switched antifungal agents to second-line drugs. Antifungal switch to second-line agents for any reasons was the only modifiable risk factor of increased costs and LOS. Choosing an appropriate first-line antifungal agent is crucial for better outcomes and reduced hospital costs of candidemia.

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“…To further explore the above factors, we decided to examine the global trends of three key variables: country-level data on healthcare antibiotic consumption (2000-2015) [85,86], antifungal consumption (2002-2018) [87][88][89][90], and the number of acute and long-term care beds (1980-2015) [91,92] in healthcare facilities. C. auris is known to afflict patients in acute and long-term care [51,81,82], however such patient populations are difficult to measure and their data are largely unavailable [93,94].…”

Section: Contrasting Geospatial Trends In Antimicrobial Usage and Host Populationsmentioning

confidence: 99%

On the emergence, spread and resistance of Candida auris: host, pathogen and environmental tipping points

Chakrabarti

Sood

2021

Journal of Medical Microbiology

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Over a decade ago, a multidrug-resistant nosocomial fungus Candida auris emerged worldwide and has since become a significant challenge for clinicians and microbiologists across the globe. A resilient pathogen, C. auris survives harsh disinfectants, desiccation and high-saline environments. It readily colonizes the inanimate environment, susceptible patients and causes invasive infections that exact a high toll. Prone to misidentification by conventional microbiology techniques, C. auris rapidly acquires multiple genetic determinants that confer multidrug resistance. Whole-genome sequencing has identified four distinct clades of C. auris, and possibly a fifth one, in circulation. Even as our understanding of this formidable pathogen grows, the nearly simultaneous emergence of its distinct clades in different parts of the world, followed by their rapid global spread, remains largely unexplained. We contend that certain host–pathogen–environmental factors have been evolving along adverse trajectories for the last few decades, especially in regions where C. auris originally appeared, until these factors possibly reached a tipping point to compel the evolution, emergence and spread of C. auris. Comparative genomics has helped identify several resistance mechanisms in C. auris that are analogous to those seen in other Candida species, but they fail to fully explain how high-level resistance rapidly develops in this yeast. A better understanding of these unresolved aspects is essential not only for the effective management of C. auris patients, hospital outbreaks and its global spread but also for forecasting and tackling novel resistant pathogens that might emerge in the future. In this review, we discuss the emergence, spread and resistance of C. auris, and propose future investigations to tackle this resilient pathogen.

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Current Usage and Prospect of New Antifungal agents in Korea

Abstract: The incidence of invasive fungal infections has been increased worldwide along with the increasing population at high risk for fungal infection. However, no data is available for the current status of usage of antifungal agents in Korea. We

Cited by 6 publications

References 18 publications

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

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

Impact of First-Line Antifungal Agents on the Outcomes and Costs of Candidemia

On the emergence, spread and resistance of Candida auris: host, pathogen and environmental tipping points

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