407. Changes in the Utilization Patterns of Antifungal Agents, Medical cost, and Clinical Outcomes of Candidemia by Healthcare Benefit Expansion to Include Newer Antifungal Agents

Background Candidemia is a major life-threatening fungal infection in hospitalized patients worldwide. In 2014, South Korea’s national health insurance expanded its coverage for newer antifungal agents such as echinocandins. This study investigated the effects of change in insurance coverage on the prescription patterns of antifungals, medical costs, and treatment outcomes of candidemia. Methods A retrospective cohort study was conducted for all hospitalized patients with candidemia at three tertiary care hospitals in South Korea from January 2012 to December 2015. The utilization of antifungal agents, medical cost, and treatment outcomes before and after the healthcare benefit expansion were compared and the factors associated with 28-day mortality during the study period were analyzed. Results A total of 769 candidemia patients were identified during the study period: from 2012 to 2015, there were 196, 199, 201, and 173 patients, respectively. The incidence of candidemia did not change during the study period (P = 0.253). The proportion of echinocandins as the initial antifungal agent and direct medical costs for candidemia significantly increased since the change in insurance coverage (P < 0.001). There was no significant difference in 28-day mortality of candidemia before and after the healthcare benefit expansion (P = 0.067). On multivariable analysis, independent factors associated with the 28-day mortality were Charlson comorbidity score (odds ratio [95% confidence interval]: 1.171 [1.080–1.269]), SOFA score (1.258 [1.185–1.335]) and initial treatment with amphotericin B (vs.: fluconazole (0.624 [0.428–0.912]) and caspofungin (0.517 [0.269–0.993]). Conclusion Although the utilization of newer antifungal agents and medical cost for candidemia has significantly increased since the healthcare benefit expansion, to include newer antifungal agents, the policy change does not seem to change the mortality rate of candidemia in South Korea. Disclosures All authors: No reported disclosures.