Medical cost analysis for antifungal prophylaxis in neutropenic patients with hematological malignancies: a systematic simulation analysis.
OBJECTIVE
We assessed the medical costs of different antifungal agents for prophylaxis of invasive fungal infections in neutropenic patients in Japan with a cost simulation model designed for the study.


METHODS
We used probabilities of prophylaxis failure, possible cases for empiric therapy, probable proportions of infections caused by fungus species among prophylaxis failure patients, and incidence of adverse events caused by any reason, based on systematic analysis of previously reported randomized trials identified by a computerized search of the PubMed database. Antifungal agents were limited to oral fluconazole, oral itraconazole, micafungin, and liposomal amphotericin B. The range of the expected medical cost was simulated as a sensitivity analysis using 95% of confidence interval of a mean.


RESULTS
Fifteen studies were identified for our analysis. The prophylactic efficacy was comparable between the four agents. The simulated expected cost for invasive fungal infection prophylaxis and treatment of the infection was $1,035.74 when oral itraconazole was used for prophylaxis, $1,552.81 with oral fluconazole, $2,245.96 with micafungin, and $3,028.10 with liposomal amphotericin B. The total cost including treatment cost for adverse events related to each drug was $2,742.14, $3,547.91, $3,034.57, and $3,028.10, respectively. This result was confirmed in a sensitivity analysis in which IFI incidence and therapy duration were tested as parameters.


CONCLUSIONS
Our analysis results suggest that oral itraconazole is the most cost-effective prophylactic antifungal agent for invasive fungal infections in neutropenic patients with hematological malignancies, and this result was robust by sensitivity analysis.
Imataki
Osamu
O
Division of Hematology, Department of Internal Medicine, Faculty of Medicine, Kagawa University, 1750-1 Ikenobe, Miki-cho, Kita-gun, Kagawa 761-0793, Japan. oima@med.kagawa-u.ac.jp
Kubota
Yoshitsugu
Y
Ohnishi
Hiroaki
H
Kitanaka
Akira
A
Ishida
Toshihiko
T
Tanaka
Terukazu
T
D000328:Adult; D000935:Antifungal Agents / Q000009:adverse effects / Q000191:economics* / Q000627:therapeutic use; D003198:Computer Simulation; D003365:Costs and Cost Analysis; D016527:Drug Costs; D005260:Female; D019337:Hematologic Neoplasms / Q000628:therapy*; D006801:Humans; D007564:Japan; D008297:Male; D008875:Middle Aged; D009181:Mycoses / Q000191:economics* / Q000517:prevention & control / Q000628:therapy; D009503:Neutropenia / Q000191:economics / Q000209:etiology*; D016032:Randomized Controlled Trials as Topic; D013997:Time Factors
D000935:Antifungal Agents