Economic evaluation of intravenous itraconazole for presumed systemic fungal infections in neutropenic patients in Korea.
Systemic fungal infections remain a major clinical problem in immunocompromised patients. Presumed systemic fungal infections (PSFI) are treated empirically with an intravenous antifungal agent to reduce the occurrence of documented infections and associated mortality. The objective of this study was to compare the cost-effectiveness of intravenous itraconazole (IVitra) treatment with the current first-line empirical treatment of PSFI with conventional amphotericin B (CAB) in cases of neutropenic cancer and bone marrow transplantation (BMT). Cost-effectiveness was expressed as cost per additional "responder" (defined as a patient without fever or major toxicity). We developed a medical decision analytical tree that included probabilities of toxicity, response and pathogen documentation, and second-line treatments. Clinical data were obtained from randomized clinical trials, and resource use data were obtained from a panel of clinical experts. The total cost of treating PSFI per neutropenic cancer patient was lower for IVitra than for CAB, and this lower cost resulted from a reduced need for second-line antifungals. In a cost-effectiveness analysis, IVitra treatment was superior to CAB treatment. Compared with current treatment with CAB, IVitra therapy was shown to be a cost-effective and cost-saving empirical treatment for PSFI in neutropenic cancer patients and BMT patients.
Moeremans
K
K
HEDM, Health Economics and Disease Management, Brussels, Belgium. KMoeremans@be.imshealth.com
Annemans
L
L
Ryu
Ji-So
JS
Choe
Kang-Won
KW
Shine
Wan-Shik
WS
D000666:Amphotericin B / Q000008:administration & dosage / Q000191:economics; D000935:Antifungal Agents / Q000008:administration & dosage / Q000191:economics*; D003365:Costs and Cost Analysis; D006801:Humans; D017964:Itraconazole / Q000008:administration & dosage / Q000191:economics*; D007723:Korea; D009181:Mycoses / Q000150:complications / Q000188:drug therapy / Q000191:economics*; D009369:Neoplasms / Q000150:complications / Q000191:economics / Q000628:therapy; D009503:Neutropenia / Q000150:complications / Q000191:economics* / Q000209:etiology; D016032:Randomized Controlled Trials as Topic
D000935:Antifungal Agents; D017964:Itraconazole; D000666:Amphotericin B