A pharmacoeconomic evaluation of capsofungin and amphotericin B for intravenous infusion for treatment of systemic fungal infection

Abstract

Empirical application of antifungal drugs in the treatment of invasive fungal infections (IFI) in febrile neutropenia represent significant cost, but it is essential in patients with leukemia and after hematopoietic stem cell transplantation. Numerous clinical studies have shown little difference in the efficacy of amphotericin B and caspofungin in IFI empirical therapy, but it does not reflect their cost-effectiveness. The aim of this study was to compare the costeffectiveness of caspofungin and amphotericin B lipid complex (ABLC) in the empirical antifungal therapy in patients with febrile neutropenia using model-decision tree, from the perspective of the National Health Insurance Fund (NHIF). We used the cost-effectiveness analysis, for a period of 14 days of therapy. In model we combined data on efficacy from randomized clinical trials, while the costs were taken from the Drug list or service fee NHIF. The total cost per additional cured fungal infection with caspofungin was 639,750.06 RSD, while with ABLC was 2,153,403.61 RSD. In the sensitivity analysis, using different weights of patients (50kg or 70kg) and different doses of ABLC, caspofungin was again most cost-effective strategy for empirical antifungal therapy. Caspofungin, in addition to a better safety profile, is more cost-efficient than ABLC. This fact should be kept in mind when choosing a therapy for the treatment of IFI in patients with febrile neutropenia.

Empirijska primena antimikotika u terapiji invazivnih gljivičnih infekcija (IGI) u febrilnoj neutropeniji predstavlja značajan trošak, ali je neophodna kod pacijenata sa leukemijom i nakon transplantacije matičnih ćelija hematopoeze. Brojne kliničke studije pokazale su male razlike u efikasnosti amfotericina B i kaspofungina u empirijskoj terapiji IGI, ali to ne oslikava u pravoj meri odnos trošak-efektivnost. Cilj rada je bio poređenje isplativosti kaspofungina i amfotericina B lipidni kompleks (ABLC) u empirijskoj antigljivičnoj terapiji kod pacijenata sa febrilnom neutropenijom kroz model-drvo odlučivanja, a iz perspektive Republičkog fonda za zdravstveno osiguranje (RFZO). Primenjena je analiza isplativosti, (cost-effectiveness analsys - CEA), za period od 14 dana terapije. U modelu su kombinovani podaci o efikasnosti iz randomizovanih kliničkih studija, dok su troškovi uzeti iz važećeg cenovnika zdravstvenih usluga i Liste lekova RFZO. Ukupan trošak po dodatno izlečenoj gljivičnoj infekciji za kaspofungin iznosi 639.750,06 RSD, dok je za ABLC 2.153.403,61 RSD. U analizi osetljivosti, primenom različite telesne težine pacijenata (50kg ili 70kg) i različite doze ABLC, kaspofungin je ponovo bio isplativija strategija empirijske antigljivične terapije. Kaspofungin, pored boljeg bezbednosnog profila je i troškovno isplativiji od ABLC. Ovu činjenicu bi trebalo imati u vidu prilikom odabira terapije za lečenje IGI kod pacijenata sa febrilnom neutropenijom.