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Journal of Clinical Microbiology, June 2007, p. 1884-1888, Vol. 45, No. 6
0095-1137/07/$08.00+0     doi:10.1128/JCM.00192-07
Copyright © 2007, American Society for Microbiology. All Rights Reserved.

To Test or Not To Test: a Cost Minimization Analysis of Susceptibility Testing for Patients with Documented Candida glabrata Fungemias{triangledown}

Curtis D. Collins,1* Gregory A. Eschenauer,1,{dagger} Susan L. Salo,2 and Duane W. Newton2

Departments of Pharmacy Services,1 Pathology, University of Michigan Health System, Ann Arbor, Michigan 481092

Received 25 January 2007/ Returned for modification 14 March 2007/ Accepted 22 March 2007

This cost minimization analysis investigated the financial impact of the treatment of fungemias due to Candida glabrata from a hospital perspective using three competing alternatives: (i) performing in-house susceptibility testing on all C. glabrata isolates and changing patients to less expensive fluconazole therapy for isolates that test susceptible; (ii) susceptibility testing at outside laboratories with delayed deescalation to fluconazole if isolates test susceptible; and (iii) no routine susceptibility testing with full echinocandin treatment course. Sensitivity analyses and Monte Carlo simulation enhanced the robustness of the model through variation of all assumptions and costs. In the base case, the use of in-house testing displayed a cost advantage over the options of send-out testing and no susceptibility testing ($2,226 versus $2,410 versus $3,136, respectively). Sensitivity analyses determined that the cost of echinocandin therapy and the turnaround time for send-out testing had the potential to impact the base case model. The decision model indicated that in-house susceptibility testing of C. glabrata isolates should result in lower overall treatment costs in patients with documented C. glabrata fungemias.

* Corresponding author. Mailing address: Department of Pharmacy Services, University of Michigan Health System, UHB2D301 University Hospital, 1500 E. Medical Center Dr., Ann Arbor, MI 48109-0008. Phone: (734) 936-8210. Fax: (734) 936-7027. E-mail: cdcollin{at}umich.edu

{triangledown} Published ahead of print on 4 April 2007.

{dagger} Present address: Department of Pharmacy at New York-Presbyterian Hospital, New York, NY 10032.

Journal of Clinical Microbiology, June 2007, p. 1884-1888, Vol. 45, No. 6
0095-1137/07/$08.00+0     doi:10.1128/JCM.00192-07
Copyright © 2007, American Society for Microbiology. All Rights Reserved.



This article has been cited by other articles:

  • Pfaller, M. A., Boyken, L. B., Hollis, R. J., Kroeger, J., Messer, S. A., Tendolkar, S., Diekema, D. J. (2008). Validation of 24-Hour Fluconazole MIC Readings versus the CLSI 48-Hour Broth Microdilution Reference Method: Results from a Global Candida Antifungal Surveillance Program. J. Clin. Microbiol. 46: 3585-3590 [Abstract] [Full Text]  


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