OBJECTIVES: Invasive candidiasis (IC) is a serious fungal infection often requiring extended hospital stays and treatment within the intensive care unit (ICU). IC-related crude mortality rates remain high, despite the widespread use of antifungal therapies. The current study aimed to quantify the burden of IC in Germany by describing the patient care pathway, associated healthcare resource utilization (HCRU) and direct healthcare costs.

METHODS: A descriptive, retrospective, cohort study examined German statutory health insurance claim data collected between July 2014 and September 2019 for inpatients with a discharge diagnosis of IC (ICD-10-GM of B37.1, B37.5, B37.6, B37.7, B37.88). All HCRU/costs used in the analysis were associated with the entire indexed hospital stay as IC-specific costs could not be captured.

RESULTS: During the study period, 6,385 patients (61.5% male, mean age (SD) 66.9 (15.2) years) had an inpatient discharge diagnosis of IC. Of those, 10.6% (n=678) had candidemia, 87.6% (n=5,593) had candidiasis and 1.79% (n=114) were diagnosed with both candidemia and candidiasis. All-cause-mortality at 30, 60, 90 days from admission was 16.4%, 24.9% and 29.0% , respectively. Mean (SD) length of stay (LoS) for the indexed hospital stay was 30.3 (29.2) days and varied according to discharge diagnosis. 13.6% of the cohort were admitted to ICU, with a mean (SD) ICU LoS of 6.77 (12.66) days among this group. The longest ICU LoS was observed in those with both candidemia and candidiasis. Total related healthcare spending was €218.9 million. Mean cost per patient was €34,287. The highest costs were observed in patients requiring ICU admission (€60,393) and those patients diagnosed with both candidemia and candidiasis (€57,866).

CONCLUSIONS: Analysis of nationwide, real-world data from Germany confirms substantial burden of IC and helps to contextualize the associated financial costs borne by the health-care system.