Candida 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.