Publication: Distribution and prognostic factors for mortality of invasive candidiasis, and cost-effectiveness analysis of three diagnostic modalities in selected Malaysian Hospitals
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Date
2024-12
Authors
Nordin, Ahmad Syazwan Ahmad
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Abstract
Invasive candidiasis (IC) is a severe fungal infection associated with high mortality and substantial healthcare costs. Despite advancements in diagnostic methods, challenges persist in achieving timely and economically viable diagnosis, particularly in resource-limited settings. Advanced non-culture diagnostics offer faster results but face limited adoption in Malaysia due to cost concerns. This study aimed to examine the distribution and trends of IC, estimate survival rates, identify prognostic factors influencing mortality, and assess the cost-effectiveness of diagnostic methods to improve patient outcomes and to inform healthcare policy.
This study comprised two parts. Part one used a retrospective cohort design to investigate IC trends, median survival time, and prognostic factors among 445 patients diagnosed between 2017 and 2023. Survival analysis, employing Kaplan-Meier analysis, revealed median survival rates stratified by demographic and clinical variables, while Cox proportional hazards regression identified significant mortality prognostic factors. Part two focused on a cost-effectiveness analysis of three diagnostic modalities: culture (M1), culture with polymerase chain reaction (M2), and culture with Mannan/anti-Mannan (M3), using a micro-costing approach. Effectiveness was assessed through lab turnaround time (LTAT), with average cost-effectiveness ratios (ACER) and incremental cost-effectiveness ratios (ICER) calculated.
The most prevalent species was Candida albicans (32.2%), followed by non-albicans species such as C. tropicalis (25.3%) and C. parapsilosis (20.3%). High mortality rates were observed, particularly among ICU patients, with a 30-day survival rate of 26.1%. Kaplan-Meier estimates revealed a median survival time of 21 days. Significant prognostic factors of mortality included kidney injury, hypertension, and sepsis. M2 and M3 demonstrated faster (LTAT < 2 days) compared to M1 (> 5 days). Average cost-effectiveness ratios for 2000 specimens quantity M2 achieved a cost of RM33.25 per day reduction in LTAT, while M3 required RM41.79. Incremental cost-effectiveness ratios demonstrated diagnosis IC using PCR or Mn A-Mn is cost-effective
The findings highlight the dominance of non-albicans Candida species and highlighted the importance of improved diagnostics and tailored treatment strategies. Incorporating PCR and Mn A-Mn diagnostics offers a cost-effective approach to enhance IC management and guide healthcare policies.