[Economic evaluation of the treatment of systemic fungal infections in immunocompromised patients: the role of itraconazole].
In recent years, the incidence of HIV infection, the intensity of chemotherapy regimens for cancer and the use of bone marrow transplantation have all increased. This results in an increase in the incidence of systemic fungal infections, which are associated high rates of morbidity and mortality in this immunosuppressed population; the incidence is growing: 50% for neutropenic/transplant bone marrow patients and 5-20% for organ transplant. Fluconazole, itraconazole, amphotericin-B and, in the recent years, caspofungin and voriconazole are the most frequently used antifungal agents. However, the newly developed formulations of itraconazole and lipid-associated formulations of amphotericin-B have provide new treatment options for systemic fungal infection and have prompted a number of comparisons of the treatment costs of empirical therapy. The i.v. formulation of itraconazole may be more cost effective than either conventional or liposomial formulations of amphotericin-B when used as empirical therapy for neutropenic patients with persistent fever despite broad spectrum antibiotic therapy, but further studies are required. The lack of studies, national and international, and the small amount of available data on the cost of systemic fungal infections mean that the costs saving from prophylactic and empirical use of antifungals are difficult to estimate.
Colombo
Giorgio L
GL
SAVE: Studi Analisi Valutazioni Economiche, Milano. giorgio.colombo@savestudi.it
Morlotti
Luca
L
Serra
Giulio
G
D000666:Amphotericin B / Q000191:economics; D000935:Antifungal Agents / Q000191:economics* / Q000627:therapeutic use; D000077336:Caspofungin; D054714:Echinocandins; D015725:Fluconazole / Q000191:economics; D006801:Humans; D016867:Immunocompromised Host; D017964:Itraconazole / Q000191:economics* / Q000627:therapeutic use; D055666:Lipopeptides; D009181:Mycoses / Q000188:drug therapy / Q000191:economics* / Q000276:immunology; D009503:Neutropenia / Q000150:complications*; D009894:Opportunistic Infections / Q000188:drug therapy / Q000191:economics* / Q000276:immunology; D010456:Peptides, Cyclic / Q000191:economics; D011743:Pyrimidines / Q000191:economics; D014230:Triazoles / Q000191:economics; D065819:Voriconazole
D000935:Antifungal Agents; D054714:Echinocandins; D055666:Lipopeptides; D010456:Peptides, Cyclic; D011743:Pyrimidines; D014230:Triazoles; D017964:Itraconazole; D000666:Amphotericin B; D015725:Fluconazole; D000077336:Caspofungin; D065819:Voriconazole