title: A cost-effectiveness analysis of caspofungin vs. liposomal amphotericin B for treatment of suspected fungal infections in the UK.
abstract: OBJECTIVE
  To evaluate the cost-effectiveness of caspofungin vs. liposomal amphotericin B in the treatment of suspected fungal infections in the UK.
  
  
  METHODS
  The cost-effectiveness of caspofungin vs. liposomal amphotericin B was evaluated using a decision-tree model. The decision tree was populated using both data and clinical definitions from published clinical studies. Model outcomes included success in terms of resolution of fever, baseline infection, absence of breakthrough infection, survival and quality adjusted life years (QALYs) saved. Discontinuation due to nephrotoxicity or other adverse events were included in the model. Efficacy and safety data were based on additional analyses of a randomised, double blind, multinational trial of caspofungin compared with liposomal amphotericin B. Information on life expectancy, quality of life, medical resource consumption and costs were obtained from peer-reviewed published data.
  
  
  RESULTS
  The caspofungin mean total treatment cost was 9762 pounds (95% uncertainty interval 6955-12,577), which was 2033 pounds (-2489; 6779) less than liposomal amphotericin B. Treatment with caspofungin resulted in 0.40 (-0.12; 0.94) additional QALYs saved in comparison with liposomal amphotericin B. Probabilistic sensitivity analysis found a 95% probability of the incremental cost per QALY saved being within the generally accepted threshold for cost-effectiveness (30,000 pounds). Additional analyses with varying dose of caspofungin and liposomal amphotericin B confirmed these findings.
  
  
  CONCLUSIONS
  Given the underlying assumptions, caspofungin is cost-effective compared with liposomal amphotericin B in the treatment of suspected fungal infections in the UK.
authors.affiliation: Mapi Values, De Molen, Houten, The Netherlands.
authors.forename: Karin
authors.initials: K
authors.lastname: Bruynesteyn
authors.forename: Vanya
authors.initials: V
authors.lastname: Gant
authors.forename: Catherine
authors.initials: C
authors.lastname: McKenzie
authors.forename: Tony
authors.initials: T
authors.lastname: Pagliuca
authors.forename: Chris
authors.initials: C
authors.lastname: Poynton
authors.forename: Ritesh N
authors.initials: RN
authors.lastname: Kumar
authors.forename: Jeroen P
authors.initials: JP
authors.lastname: Jansen
mesh_terms: D000666:Amphotericin B / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D000935:Antifungal Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D000077336:Caspofungin; D003362:Cost-Benefit Analysis; D004311:Double-Blind Method; D054714:Echinocandins; D006801:Humans; D007902:Length of Stay / Q000191:economics; D055666:Lipopeptides; D008081:Liposomes; D009181:Mycoses / Q000188:drug therapy*; D010456:Peptides, Cyclic / Q000009:adverse effects / Q000627:therapeutic use*; D019057:Quality-Adjusted Life Years; D006113:United Kingdom
chemical_list: D000935:Antifungal Agents; D054714:Echinocandins; D055666:Lipopeptides; D008081:Liposomes; D010456:Peptides, Cyclic; D000666:Amphotericin B; D000077336:Caspofungin