title: Economic evaluation of caspofungin vs liposomal amphotericin B for empirical therapy of suspected systemic fungal infection in the German hospital setting.
abstract: As antifungal agents are frequently used in hematology and oncology, economic data on the empirical therapy of suspected systemic fungal infection are pivotal. Data were analyzed according to: (1) the rate of nephrotoxicity related to treatment with caspofungin in comparison to liposomal amphotericin B (L-AmB) from a randomized clinical trial, (2) the effect of nephrotoxicity on length of hospital stay from a European observational study, and (3) an example of total bottom-up cost in a department of hematology in Germany. All estimates include 95% confidence intervals (CI) using two-stage Monte Carlo simulation on binominal and Gaussian random variables from separate studies with comparable populations. Overall, 8.9 (95% CI 5.9-12.1) fewer patients (of 100 randomized) experienced worsening of renal function with caspofungin vs L-AmB, giving a number needed to treat for one patient to be harmed by L-AmB of 12 (95% CI 8-17). This was estimated to translate into 5.3 extra days in hospital (95% CI 1.6-9.1) per event or 0.48 days (95% CI 0.14-0.88) worth 298 euro (95% CI 89-554) per patient receiving L-AmB rather than caspofungin. From the hospital perspective, use of caspofungin was estimated to be cost-neutral compared to L-AmB at a per diem total hospital cost of 428 euro with, and 1284 euro without, consideration of supplementary reimbursement (Zusatzentgelt) of both L-AmB and caspofungin. The data presented in this scenario show that use of caspofungin in hematology-oncology departments in Germany results in shorter hospital stays and is at least cost-neutral compared to use of L-AmB.
authors.affiliation: Outcomes Research, MSD Sharp and Dohme GmbH, Haar, Germany. peter_kaskel@msd.de
authors.forename: Peter
authors.initials: P
authors.lastname: Kaskel
authors.forename: Silja
authors.initials: S
authors.lastname: Tuschy
authors.forename: Alexander
authors.initials: A
authors.lastname: Wagner
authors.forename: Christian
authors.initials: C
authors.lastname: Bannert
authors.forename: Oliver A
authors.initials: OA
authors.lastname: Cornely
authors.forename: Axel
authors.initials: A
authors.lastname: Glasmacher
authors.forename: Hans-Peter
authors.initials: HP
authors.lastname: Lipp
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Ullmann
mesh_terms: D000666:Amphotericin B / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use*; D000935:Antifungal Agents / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use*; D000077336:Caspofungin; D003365:Costs and Cost Analysis; D004311:Double-Blind Method; D054714:Echinocandins / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use*; D005858:Germany; D006801:Humans; D055666:Lipopeptides; D008081:Liposomes; D008137:Longitudinal Studies; D009181:Mycoses / Q000188:drug therapy* / Q000517:prevention & control; D011446:Prospective Studies
chemical_list: D000935:Antifungal Agents; D054714:Echinocandins; D055666:Lipopeptides; D008081:Liposomes; D000666:Amphotericin B; D000077336:Caspofungin