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.

Keywords

• amphotericin b
• caspofungin
• febrile neutropenia
• cost-effectiveness