Background: Treatment of AIA typically involves prolonged hospitalization and substantial use of intensive care (ICU) resources. This study compared consumption of hospital resources by AIA pts receiving initial treatment with either VOR or CAB.

Methods: Data were collected prospectively as part of a clinical trial comparing VOR to CAB in AIA of immunocompromised pts, where VOR showed a significant improvement in success and a relative survival benefit (

Herbrecht R et al, NEJM 2002; 347: 408–15
). Pts in the modified-intent-to-treat population with completed resource utilization data were included. Total days of hospitalization, days of ICU, and hospitalization-free survival days during 12 weeks following initiation of therapy were compared. The impact of survival on resource consumption was explored.

Results: There were 143 and 131 pts in the VOR and CAB arms, respectively, with resource utilization data. Resource utilization data are presented in the Table.

Resource Utilization by Treatment Arm

VOR Mean (SD)CAB Mean (SD)Difference (95% CI)
Total Hospital Days 27.8 (22.7) 27.7 (20.8) 0.1 (−5.1, 5.3) 
Total Hospital Days (survivors) 30.2 (24.2) 33.3 (22.2) −3.1 (−10.3, 4.0) 
ICU Days 5.6 (10.7) 8.1 (14.4) −2.5 (−5.5, 0.5) 
ICU Days (survivors) 4.0 (10.9) 8.1 (14.6) −4.1 (−7.9, −0.2) 
Hospitalization-free survival (days) 40.3 (29.8) 28.4 (28.5) 11.9 (4.9, 18.8) 
VOR Mean (SD)CAB Mean (SD)Difference (95% CI)
Total Hospital Days 27.8 (22.7) 27.7 (20.8) 0.1 (−5.1, 5.3) 
Total Hospital Days (survivors) 30.2 (24.2) 33.3 (22.2) −3.1 (−10.3, 4.0) 
ICU Days 5.6 (10.7) 8.1 (14.4) −2.5 (−5.5, 0.5) 
ICU Days (survivors) 4.0 (10.9) 8.1 (14.6) −4.1 (−7.9, −0.2) 
Hospitalization-free survival (days) 40.3 (29.8) 28.4 (28.5) 11.9 (4.9, 18.8) 
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Conclusion: VOR pts had significantly longer hospitalization-free survival and had a trend toward fewer ICU days than CAB pts. Improved survival with less hospital resource utilization and lower total drug acquisition costs (Lewis JS et al, ICAAC 2003, A1359) support the economic benefit of using VOR for primary therapy for AIA.

Topics:
amphotericin b, aspergillosis, invasive, brachial plexus neuritis, voriconazole, intensive care, intensive care unit, survivors, arm, interscience conference on antimicrobial agents and chemotherapy

Author notes

Corresponding author

2005, The American Society of Hematology
2004
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