Pharmacoeconomic analysis of caspofungin versus liposomal amphotericin B as empirical antifungal therapy for neutropenic fever.
OBJECTIVE
An analysis was conducted that evaluated and compared the cost differences between caspofungin and liposomal amphotericin B when the medications were used as empirical antifungal therapy for persistent fever during neutropenia.


METHODS
Rates of drug use and impaired renal function (IRF) were based on data from published studies. IRF was defined as a doubling of the serum creatinine level or, if the creatinine level was elevated at enrollment, an increase of at least 1 mg/dL. The estimates of the costs for drug acquisition and treating IRF were derived using published data and applied to compare caspofungin with liposomal amphotericin B. Sensitivity analyses were performed by varying the IRF and relative acquisition costs to assess the effect of these factors on the cost differences.


RESULTS
The acquisition costs per patient were 6942 dollars for liposomal amphotericin B and 3996 dollars for caspofungin. The estimated cost per patient from IRF was 3173 dollars for liposomal amphotericin B and 793 dollars for caspofungin. Combining drug acquisition and IRF costs, the overall treatment cost per patient for caspofungin was 5326 dollars less than for liposomal amphotericin B. In sensitivity analyses of drug costs, the price of liposomal amphotericin B would have to be 23.95 dollars per vial for the overall treatment costs to be equal.


CONCLUSIONS
Comparison of cost estimates derived from published data revealed that a combined estimate of acquisition costs and costs related to the treatment of IRF was lower for caspofungin than for liposomal amphotericin B for empirically treating patients with neutropenic fever.
Wingard
John R
JR
Division of Hematology and Oncology, College of Medicine, University of Florida Shands Cancer Center, Gainesville, Florida 32610-0277, USA. wingajr@medicine.ufl.edu
Leather
Helen L
HL
Wood
Craig A
CA
Gerth
William C
WC
Lupinacci
Robert J
RJ
Berger
Marc L
ML
Mansley
Edward C
EC
D000666:Amphotericin B / Q000009:adverse effects / Q000191:economics*; D000935:Antifungal Agents / Q000009:adverse effects / Q000191:economics*; D000077336:Caspofungin; D003362:Cost-Benefit Analysis; D016527:Drug Costs / Q000706:statistics & numerical data; D054714:Echinocandins; D005334:Fever / Q000188:drug therapy* / Q000191:economics; D006801:Humans; D007677:Kidney Function Tests; D055666:Lipopeptides; D008081:Liposomes; D009503:Neutropenia / Q000188:drug therapy* / Q000191:economics; D010456:Peptides, Cyclic / Q000009:adverse effects / Q000191:economics*; D051437:Renal Insufficiency / Q000139:chemically induced / Q000191:economics; D012189:Retrospective Studies; D012680:Sensitivity and Specificity
D000935:Antifungal Agents; D054714:Echinocandins; D055666:Lipopeptides; D008081:Liposomes; D010456:Peptides, Cyclic; D000666:Amphotericin B; D000077336:Caspofungin