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JAC Advance Access originally published online on November 11, 2008
Journal of Antimicrobial Chemotherapy 2009 63(1):197-208; doi:10.1093/jac/dkn459
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© The Author 2008. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

Original research

Cost-effectiveness evaluation of voriconazole versus liposomal amphotericin B as empirical therapy for febrile neutropenia in Australia

Daoud Al-Badriyeh1, Danny Liew2, Kay Stewart1 and David C. M. Kong1,*

1 Department of Pharmacy Practice, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, 381 Royal Parade, Parkville, Victoria 3052, Australia 2 Department of Medicine, St Vincent's Hospital, University of Melbourne, 41 Victoria Parade, Fitzroy, Victoria 3065, Australia

Received 17 June 2008; returned 24 July 2008; revised 1 September 2008; accepted 10 October 2008

* Corresponding author. Tel: +61-3-9903-9035; Fax: +61-3-9903-9629; E-mail: david.kong{at}pharm.monash.edu.au

Objectives: A major randomized clinical trial, evaluating voriconazole versus liposomal amphotericin B (LAMB) as empirical therapy in febrile neutropenia, recommended voriconazole as a suitable alternative to LAMB. The current study sought to investigate the health economic impact of using voriconazole and LAMB for febrile neutropenia in Australia.

Methods: A decision analytic model was constructed to capture downstream consequences of empirical antifungal therapy with each agent. The main outcomes were: success, breakthrough fungal infection, persistent baseline fungal infection, persistent fever, premature discontinuation and death. Underlying transition probabilities and treatment patterns were derived directly from trial data. Resource use was estimated using an expert panel. Cost inputs were obtained from the latest Australian representative published sources. The perspective adopted was that of the Australian hospital. Uncertainty and sensitivity analyses were undertaken via the Monte Carlo simulation.

Results: Compared with voriconazole, LAMB was associated with a net cost saving of AU$1422 (2.9%) per patient. A similar trend was observed with the cost per death prevented and successful treatment. LAMB dominated voriconazole as it resulted in higher efficacy and lower costs when compared with voriconazole. The results were most sensitive to the duration of therapy and the alternative therapy used post discontinuations. In uncertainty analysis, LAMB had 99.8% chance of costing less than voriconazole.

Conclusions: In this study, which used the current standard five component endpoint to assess the impact of empirical antifungal therapy, LAMB was associated with cost savings relative to voriconazole.

Keywords: economic , model , empirical antifungal


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D. Al-Badriyeh, D. Liew, K. Stewart, and D. C. M. Kong
Economic impact of caspofungin as compared with liposomal amphotericin B for empirical therapy in febrile neutropenia in Australia
J. Antimicrob. Chemother., June 1, 2009; 63(6): 1276 - 1285.
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