Cost-benefit assessment of antifungal prophylaxis with liposomal amphotericin B in neutropenic patients.
BACKGROUND
In a recently reported randomized trial, low-dose intravenous liposomal amphotericin B (L-AmB) reduced the incidence of invasive fungal infections (20.2 vs. 4.6%, p < 0.001) in high-risk patients with hematological malignancies and prolonged neutropenia.


METHODS
In the present study, we performed a retrospective cost-benefit analysis of L-AmB prophylaxis from the hospital perspective.


RESULTS
Ninety-nine patients were eligible; baseline characteristics were balanced for age, sex, underlying disease, and duration of neutropenia. The mean duration of hospitalization was 42.9 days and 52.3 days in the prophylaxis arm and in patients without antifungal prophylaxis, respectively (p = 0.096). The L-AmB prophylaxis was associated with additional costs of approximately EUR 630 per patient. However, total medication costs (including L-AmB prophylaxis) were EUR 1,219 and EUR 2,815 in patients with L-AmB prophylaxis and in patients in the control arm, respectively (p < 0.001). When involving also costs for medical procedures, the L-AmB prophylaxis reaches a positive net benefit of EUR 1,094 per patient.


CONCLUSIONS
Our data shows that antifungal prophylaxis, e.g. with L-AmB, can be a safe and effective strategy to reduce the frequency of invasive fungal infections in selected high-risk patients and to obtain significant cost savings for the hospital.
Department of Hematology, Oncology, and Transfusion Medicine, Charité Campus Benjamin Franklin, Berlin, Germany. olaf.penack@charite.de
Olaf
O
Penack
Thomas
T
Reinhold
Eckhard
E
Thiel
Igor Wolfgang
IW
Blau
D000666:Amphotericin B / Q000191:economics* / Q000627:therapeutic use*; D000935:Antifungal Agents / Q000191:economics / Q000627:therapeutic use; D015897:Comorbidity; D017281:Cost of Illness; D003362:Cost-Benefit Analysis; D005260:Female; D005858:Germany / Q000453:epidemiology; D019337:Hematologic Neoplasms / Q000188:drug therapy / Q000191:economics / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009181:Mycoses / Q000188:drug therapy* / Q000191:economics* / Q000453:epidemiology; D009503:Neutropenia / Q000191:economics* / Q000453:epidemiology / Q000517:prevention & control*; D018570:Risk Assessment; D012307:Risk Factors; D016896:Treatment Outcome
D000935:Antifungal Agents; C068538:liposomal amphotericin B; D000666:Amphotericin B