title: Cost-effectiveness analysis comparing two approaches for empirical antifungal therapy in hematological patients with persistent febrile neutropenia.
abstract: New approaches of empirical antifungal therapy (EAT) in selected hematological patients with persistent febrile neutropenia (PFN) have been proposed in recent years, but their cost-effectiveness has not been studied. The aim of this study was to compare the cost-effectiveness of two different approaches of EAT in hematological patients with PFN: the diagnosis-driven antifungal therapy (DDAT) approach versus the standard approach of EAT. A decision tree to assess the cost-effectiveness of both approaches was developed. Outcome probabilities and treatment pathways were extrapolated from two studies: a prospective cohort study following the DDAT approach and a randomized clinical trial following the standard approach. Uncertainty was undertaken through sensitivity analyses and Monte Carlo simulation. The average effectiveness and economic advantages in the DDAT approach compared to the standard approach were 2.6% and €5,879 (33%) per PFN episode, respectively. The DDAT was the dominant approach in the 99.5% of the simulations performed with average cost-effectiveness per PFN episode of €32,671 versus €52,479 in the EAT approach. The results were robust over a wide range of variables. The DDAT approach is more cost-effective than the EAT approach in the management of PFN in hematological patients.
authors.affiliation: Clinical Unit of Infectious Disease, Microbiology and Preventive Medicine, Institute of Biomedicine of Seville, University Hospital Virgen del Rocío/CSIC/University of Seville, Seville, Spain.
authors.forename: Almudena
authors.initials: A
authors.lastname: Martín-Peña
authors.forename: M Victoria
authors.initials: MV
authors.lastname: Gil-Navarro
authors.forename: Manuela
authors.initials: M
authors.lastname: Aguilar-Guisado
authors.forename: Ildefonso
authors.initials: I
authors.lastname: Espigado
authors.forename: Maite Ruiz Pérez
authors.initials: MR
authors.lastname: de Pipaón
authors.forename: José
authors.initials: J
authors.lastname: Falantes
authors.forename: Jerónimo
authors.initials: J
authors.lastname: Pachón
authors.forename: José M
authors.initials: JM
authors.lastname: Cisneros
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000465:Algorithms; D000935:Antifungal Agents / Q000191:economics / Q000627:therapeutic use*; D064147:Febrile Neutropenia / Q000188:drug therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010802:Phylogeny; D011446:Prospective Studies; D016032:Randomized Controlled Trials as Topic; D055815:Young Adult
chemical_list: D000935:Antifungal Agents