To test or not to test:: A cost minimization analysis of susceptibility testing for patients with documented Candida glabrata fungemias

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.