title: Cost-effectiveness evaluation of voriconazole versus liposomal amphotericin B as empirical therapy for febrile neutropenia in Australia.
abstract: OBJECTIVE
  A major randomized clinical trial, evaluating voriconazole versus liposomal amphotericin B (LAMB) as empirical therapy in febrile neutropenia, recommended voriconazole as a suitable alternative to LAMB. The current study sought to investigate the health economic impact of using voriconazole and LAMB for febrile neutropenia in Australia.
  
  
  METHODS
  A decision analytic model was constructed to capture downstream consequences of empirical antifungal therapy with each agent. The main outcomes were: success, breakthrough fungal infection, persistent baseline fungal infection, persistent fever, premature discontinuation and death. Underlying transition probabilities and treatment patterns were derived directly from trial data. Resource use was estimated using an expert panel. Cost inputs were obtained from the latest Australian representative published sources. The perspective adopted was that of the Australian hospital. Uncertainty and sensitivity analyses were undertaken via the Monte Carlo simulation.
  
  
  RESULTS
  Compared with voriconazole, LAMB was associated with a net cost saving of AU$1422 (2.9%) per patient. A similar trend was observed with the cost per death prevented and successful treatment. LAMB dominated voriconazole as it resulted in higher efficacy and lower costs when compared with voriconazole. The results were most sensitive to the duration of therapy and the alternative therapy used post discontinuations. In uncertainty analysis, LAMB had 99.8% chance of costing less than voriconazole.
  
  
  CONCLUSIONS
  In this study, which used the current standard five component endpoint to assess the impact of empirical antifungal therapy, LAMB was associated with cost savings relative to voriconazole.
authors.affiliation: Department of Pharmacy Practice, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, 381 Royal Parade, Parkville, Victoria 3052, Australia.
authors.forename: Daoud
authors.initials: D
authors.lastname: Al-Badriyeh
authors.forename: Danny
authors.initials: D
authors.lastname: Liew
authors.forename: Kay
authors.initials: K
authors.lastname: Stewart
authors.forename: David C M
authors.initials: DC
authors.lastname: Kong
mesh_terms: D000666:Amphotericin B / Q000191:economics* / Q000627:therapeutic use*; D001315:Australia; D003362:Cost-Benefit Analysis; D005334:Fever; D006801:Humans; D009181:Mycoses / Q000150:complications / Q000188:drug therapy*; D009503:Neutropenia; D011743:Pyrimidines / Q000191:economics* / Q000627:therapeutic use*; D016896:Treatment Outcome; D014230:Triazoles / Q000191:economics* / Q000627:therapeutic use*; D065819:Voriconazole
chemical_list: D011743:Pyrimidines; D014230:Triazoles; C068538:liposomal amphotericin B; D000666:Amphotericin B; D065819:Voriconazole