JAC Advance Access originally published online on April 3, 2009
Journal of Antimicrobial Chemotherapy 2009 63(6):1276-1285; doi:10.1093/jac/dkp119
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Original research |
Economic impact of caspofungin as compared with liposomal amphotericin B for empirical therapy in febrile neutropenia in Australia
1 Centre for Medicine Use and Safety, 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 22 January 2009; returned 21 February 2009; revised 7 March 2009; accepted 9 March 2009
* Corresponding author. Tel: +61-3-9903-9035; Fax: +61-3-9903-9629; E-mail: david.kong{at}pharm.monash.edu.au
Background: In a major clinical trial, caspofungin was as efficacious as liposomal amphotericin B (LAmB) for empirical therapy in febrile neutropenia. The current study sought to evaluate the economic impact of caspofungin as compared with LAmB for febrile neutropenia in Australia.
Methods: A decision analytic model was developed to capture the downstream consequences of the empirical antifungal therapy. The main outcomes were success, breakthrough infection, persistent baseline 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 sources. The perspective adopted was that of the Australian hospital system. Uncertainty and sensitivity analyses were undertaken via Monte Carlo simulation.
Results: Caspofungin was associated with a net cost saving of AU$7245 (12.6%) per patient over LAmB (AU$50 267 versus AU$57 512). A similar trend was observed with cost per success and death prevented (AU$24 169 and AU$7270, respectively). Caspofungin dominated LAmB as it resulted in higher efficacy and lower costs when compared with LAmB. Persistent fever was the main contributing clinical outcome to the therapeutic costs of both antifungals. The results were most sensitive to therapy duration. Monte Carlo simulation suggested a 99.8% chance for LAmB to cost more than caspofungin.
Conclusions: This is the first economic study to evaluate the place of caspofungin as empirical therapy in Australia. Caspofungin is more cost-beneficial than LAmB, which contradicts the current Australian guidelines of recommending LAmB as the first choice for empirical therapy.
Keywords: model , LAmB , costs