The Ministry of Health Endemic Mycoses Program is essential in SUS, ensuring access to high-cost antifungals for patients with systemic fungal infections, according to RENAME and Clinical Protocols and Therapeutic Guidelines, requiring clinical and laboratory diagnosis. This study aimed to characterize cases treated through the program in a high-complexity university hospital and secondarily to evaluate the pharmacoeconomic impact of approved treatments. Cross-sectional study (January–June 2025) including hospitalized and outpatient users of program antifungals (itraconazole, liposomal amphotericin B, lipid complex amphotericin B, flucytosine, isavuconazole, and voriconazole oral and injectable). Cases with insufficient data were excluded. Methods focused on demographic and clinical characterization and on direct treatment costs, based on mean cost recorded in the hospital system. The study included 38 patients (40 encounters). Most were adults (84. 2%; mean age 51) and male (63. 2%). Immunocompetence-impacting comorbidities included oncologic diseases (25%), autoimmune diseases (22. 5%), and solid organ transplant (20%). Of encounters, 90% were hospitalizations (mean length 47 days), with 61. 1% discharges and 33. 3% deaths. The most prevalent fungal diseases were invasive pulmonary aspergillosis (37. 5%) and cryptococcosis (17. 5%). The most used antifungals and mean treatment durations (days) were: lipid complex amphotericin B (35%; 12), oral voriconazole (35%; 20. 5), IV voriconazole (30%; 14), liposomal amphotericin B (17. 5%; 20), and oral flucytosine (17. 5%; 14). Total treatment costs reached R 750, 739. 94, with liposomal amphotericin B (R 505, 961. 82) and lipid complex amphotericin B (R 134, 873. 76) as main contributors. The study highlights the importance of the Endemic Mycoses Program for high-complexity hospitals, ensuring treatment access for immunocompromised patients with severe fungal infections requiring long hospital stays. The high treatment costs offset by the program reinforce its crucial role in financial management and in ensuring adequate care, emphasizing the need to optimize management of these complex infections.
Barros et al. (Sun,) studied this question.