title: Economic evaluation of caspofungin versus liposomal amphotericin B for empiric antifungal treatment in patients with neutropenic fever in Italy.
abstract: OBJECTIVE
  To evaluate the cost-effectiveness of caspofungin versus liposomal amphotericin B as empiric antifungal treatment in patients with neutropenic fever in Italy.
  
  
  METHODS
  The cost-effectiveness of caspofungin versus liposomal amphotericin B was evaluated using a decision-tree model. Patients were stratified by presence or absence of baseline infection. Model outcomes included success in terms of resolution of fever, resolution of baseline infection, absence of breakthrough infection, survival, and quality-adjusted life years (QALYs) saved. Discontinuation because of nephrotoxicity or other adverse events were included in the model. Efficacy and safety data were based on a randomized, double-blind, multinational trial of caspofungin compared to liposomal amphotericin B (Walsh 2004). Information on life expectancy, quality of life, medical resource consumption, and costs was obtained from the literature.
  
  
  RESULTS
  The caspofungin estimated total treatment cost amounted to 8351 euros (95% uncertainty interval 7801 euros-8903 euros), which is 3470 euros (2575 euros-4382 euros) less than with liposomal amphotericin B. Treatment with caspofungin resulted in 0.25 (-0.11; 0.59) QALYs saved in comparison to treatment with liposomal amphotericin B. Probabilistic sensitivity analysis demonstrated a 93% probability that caspofungin was economically dominant, i.e., cost and QALY saving, and a probability of more than 99% that the costs per QALY saved were below 20,000 euros, a commonly accepted threshold for cost-effectiveness. Additional analyses with alternative doses of liposomal amphotericin B confirmed these findings.
  
  
  CONCLUSIONS
  Given the underlying assumptions, our economic evaluation demonstrated that caspofungin is cost-effective compared to liposomal amphotericin B in empiric antifungal treatment of patients with neutropenic fever in Italy.
authors.affiliation: Mapi Values, Houten, The Netherlands. wiro.stam@mapivalues.com
authors.forename: Wiro B
authors.initials: WB
authors.lastname: Stam
authors.forename: Franco
authors.initials: F
authors.lastname: Aversa
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 / Q000191:economics* / Q000627:therapeutic use; D000935:Antifungal Agents / Q000191:economics* / Q000627:therapeutic use; D000077336:Caspofungin; D003362:Cost-Benefit Analysis; D003661:Decision Support Techniques; D003663:Decision Trees; D054714:Echinocandins / Q000191:economics* / Q000627:therapeutic use; D005334:Fever / Q000188:drug therapy* / Q000191:economics; D005335:Fever of Unknown Origin / Q000188:drug therapy / Q000191:economics; D006801:Humans; D007558:Italy; D007902:Length of Stay; D055666:Lipopeptides; D009503:Neutropenia / Q000188:drug therapy* / Q000191:economics; D019057:Quality-Adjusted Life Years; D013997:Time Factors
chemical_list: D000935:Antifungal Agents; D054714:Echinocandins; D055666:Lipopeptides; C068538:liposomal amphotericin B; D000666:Amphotericin B; D000077336:Caspofungin