Health-care utilization and outcomes of patients at high risk of invasive fungal infection

Abstract

PurposeThe objectives of this study were to present trends in posaconazole use over time and describe selected outcomes among patients at high risk of invasive fungal infections (IFIs) by use and type of antifungal medicine.MethodsA retrospective observational study using data from the Premier Healthcare Database between January 2007 and March 2016 was conducted. Inpatient use of posaconazole by formulation and year is described. Separately, four cohorts of patients at high risk of IFI – those with acute myeloid leukemia (AML), myelodysplastic syndrome (MDS), hematopoietic stem-cell transplantation (HSCT), and graft-vs-host disease (GVHD) – but without a diagnosis code for IFI during the index encounter were identified as potential candidates for antifungal prophylaxis. Use of antifungal medication(s) in these patients was categorized. Index length of stay (LOS), index hospital costs, and subsequent inpatient and outpatient encounters with IFI at 30, 60, and 90 days post-index encounter are presented by antifungal group for each cohort. The percentage of patients with inpatient and outpatient encounters with IFI at 90 days post-index encounter was determined for each cohort by year.ResultsUse of posaconazole oral suspension increased through 2012, then declined as the tablet formulation became available in 2013. A total of 19,872 AML patients, 12,125 MDS patients, 14,220 HSCT patients, and 5,431 GVHD patients were considered potential candidates for antifungal prophylaxis; however, a large proportion of patients within each cohort (33%–94%) did not receive any antifungal drug during the index hospitalization. Index LOS, hospital costs, and subsequent encounters for IFI varied among cohorts and by antifungal group. Within each cohort, subsequent encounters for IFI at 90 days post-index encounter fluctuated but remained rare across different years.ConclusionOver time and as new posaconazole formulations became available, the frequency of use of each formulation changed. In addition, this study suggested a low rate of potential antifungal prophylaxis in high-risk patients. This is one of the first reports attempting to describe antifungal prophylaxis in a contemporary, large, all-payer, geographically representative hospital database.

Real‐world effectiveness of antifungal prophylaxis with posaconazole as the primary agent in patients with haematological malignancies

“…In fact, in a recent study examining trends in inpatient posaconazole utilisation in acute care hospitals in the United States from 2007 to March 2016, a large proportion of patients with AML/MDS or HSCT recipients who were considered candidates for antifungal prophylaxis did not receive it during their index hospitalisation. 15 This study also noted a trend of S1).…”

“…We anticipated that even if a patient was appropriately started on antifungal prophylaxis, regimen changes or interruption may be necessary for many reasons. In fact, in a recent study examining trends in inpatient posaconazole utilisation in acute care hospitals in the United States from 2007 to March 2016, a large proportion of patients with AML/MDS or HSCT recipients who were considered candidates for antifungal prophylaxis did not receive it during their index hospitalisation 15 . This study also noted a trend of increased use of the posaconazole DR tablets from 2013 to 2015 and a decrease in the use of posaconazole oral suspension after a peak in 2012.…”

“…12,13 Subsequent studies have assessed the clinical effectiveness of posaconazole prophylaxis outside of the clinical trial setting. 14,15 However, these were focused on the suspension formulation of posaconazole, which has poor and variable bioavailability.…”

Oral Manifestations and Complications in Childhood Acute Myeloid Leukemia

“…The use of antifungal prophylaxis, such as posaconazole formulations, is necessary in high-risk patients [37]. The prevention of invasive fungal infections is important in patients with AML receiving cytoreductive chemotherapy.…”

Healthcare resource utilization and economic burden of antifungal management in patients with hematologic malignancy in Japan: a retrospective database study

“…Invasive fungal infections (IFIs) are common in high-risk patients with hematologic malignancies, such as acute myeloid leukemia (AML) or myelodysplastic syndromes (MDS), who receive aggressive immunosuppressive therapy such as induction chemotherapy or allogenic hematopoietic stem cell transplantation [1][2][3][4][5][6][7][8][9][10] . The morbidity and mortality from IFIs in these high-risk patient populations is substantial 1,[3][4][5][6][7][8]10,11 .…”