Cost effectiveness of amphotericin B plus G-CSF compared with amphotericin B monotherapy. Treatment of presumed deep-seated fungal infection in neutropenic patients in the UK.
OBJECTIVE
To assess the economic impact of adding granulocyte colony-stimulating factor (G-CSF) to amphotericin B to treat a presumed deep-seated fungal infection in neutropenic patients. This study was conducted from the perspective of the National Health Service (NHS) hospital sector.


METHODS
We used our previously reported trial as the clinical basis for the analysis (see Participants and interventions). These data were combined with resource utilisation data, enabling us to construct a decision tree model of the treatment paths attributable to managing patients in each arm of the trial. The model was used to calculate the cost effectiveness of using amphotericin B plus G-CSF compared to amphotericin B monotherapy in neutropenic patients with a presumed deep-seated fungal infection.


METHODS
An adult leukaemia/bone marrow transplant (BMT) unit in a large UK teaching hospital.


METHODS
Patients with a neutrophil count of < 0.5 x 10(9)/L and having a presumed deep-seated fungal infection after either chemotherapy or stem cell/bone marrow transplantation for haematological malignancy.


METHODS
29 patients received intravenous amphotericin B (1 mg/kg daily) plus subcutaneous G-CSF (3 to 5 micrograms/kg daily) and 30 patients received intravenous amphotericin B (1 mg/kg daily) monotherapy. The clinical trial showed that 62% of patients responded to antifungal treatment with amphotericin B plus G-CSF compared to 33% of patients who responded to amphotericin B monotherapy (p = 0.027). Nonresponders went on to receive a lipid formulation of amphotericin B.


RESULTS
The mean cost per patient treated with amphotericin B plus G-CSF was 11,247 Pounds and the corresponding cost for amphotericin B monotherapy was 14,317 Pounds (1996/1997 values)--a cost reduction of 3070 Pounds per patient. Sensitivity analyses demonstrated that the addition of G-CSF to conventional amphotericin B in the treatment of a presumed deep-seated fungal infection offers not only clinical benefits, but cost benefits which are robust to changes in clinical and economic parameters.


CONCLUSIONS
From a UK hospital perspective, amphotericin B plus G-CSF is cost effective compared with amphotericin B monotherapy in managing a presumed deep-seated fungal infection in neutropenic patients. This result should provide strong arguments to clinicians and policy-makers for the adoption of this treatment strategy in such patients.
Flynn
T N
TN
Catalyst Health Economics Consultants Ltd, Pinner, Middlesex, UK.
Kelsey
S M
SM
Hazel
D L
DL
Guest
J F
JF
D000328:Adult; D000666:Amphotericin B / Q000191:economics* / Q000627:therapeutic use*; D000935:Antifungal Agents / Q000191:economics* / Q000627:therapeutic use*; D003362:Cost-Benefit Analysis; D003663:Decision Trees; D004359:Drug Therapy, Combination; D016179:Granulocyte Colony-Stimulating Factor / Q000191:economics* / Q000627:therapeutic use*; D006801:Humans; D009181:Mycoses / Q000150:complications / Q000188:drug therapy* / Q000191:economics*; D009503:Neutropenia / Q000150:complications*; D006113:United Kingdom
D000935:Antifungal Agents; D016179:Granulocyte Colony-Stimulating Factor; D000666:Amphotericin B