title: Budget impact analysis of liposomal amphotericin B and amphotericin B lipid complex in the treatment of invasive fungal infections in the United States.
abstract: BACKGROUND
  Liposomal amphotericin B (L-AMB) and amphotericin B lipid complex (ABLC) are both indicated for treating invasive fungal infections (IFIs) caused by Aspergillus, Candida and Cryptococcus spp. among patients who are refractory to or intolerant of conventional amphotericin B (CAB). Prior studies have suggested similar efficacies but differences in adverse event (AE) profiles between L-AMB and ABLC.
  
  
  OBJECTIVE
  Our objective was to conduct a cost-minimisation and budget impact analysis for the treatment of IFIs with L-AMB and ABLC in a US hospital setting.
  
  
  METHODS
  A Microsoft® Excel-based budget impact model was developed to estimate the costs associated with using L-AMB and ABLC for the treatment of adult patients with Aspergillus, Candida and Cryptococcus spp. infections, who are refractory to or intolerant of CAB, during a hospital stay. The model was built from a hospital perspective, and included drug costs of L-AMB and ABLC, and costs for treating drug-related AEs (i.e. nephrotoxicity with/without dialysis, infusion-related reactions, anaphylaxis, hypomagnesaemia and hypokalaemia). Average sales price was used as the drug cost estimate in the base-case analyses. The treatment duration and rates of AEs for L-AMB and ABLC were mainly obtained from a retrospective study of these two drugs in the target population using the Cerner Health Facts data. Treatment costs of AEs were obtained from the publicly available sources. The budget impact ($US, year 2011 values) was evaluated for a hypothetical hospital with 100 administrations where L-AMB and ABLC are used for the treatment of the target population by changing the market share of L-AMB and ABLC from 32/68% to an anticipated market share of 60/40% in the base-case analysis. Sensitivity analyses were conducted by varying drug costs, rates of AEs, costs of AEs and anticipated market shares of L-AMB and ABLC.
  
  
  RESULTS
  The estimated per-patient cost per hospital episode associated with L-AMB and ABLC use were $US14,563 and $US16,748, respectively. Cost of AEs accounted for 68.7% of the costs for L-AMB and 85.4% for ABLC. In a hypothetical hospital with 100 annual admissions of patients using these two drugs for IFIs, changing the market shares from 32/68% for L-AMB and ABLC, respectively, to 60/40% yielded a 3.8% cost reduction, which corresponded to an absolute cost savings of $US61,191. Sensitivity analyses indicated that the results were robust to changes in input parameter values in most cases.
  
  
  CONCLUSIONS
  This study suggests that hospitals can realize cost savings by substituting L-AMB for ABLC in the treatment of IFIs. The cost savings are driven by the lower rates of AEs associated with L-AMB use compared with ABLC.
authors.affiliation: Analysis Group, Inc., Boston, MA, USA.
authors.forename: Hongbo
authors.initials: H
authors.lastname: Yang
authors.forename: Paresh
authors.initials: P
authors.lastname: Chaudhari
authors.forename: Zheng-Yi
authors.initials: ZY
authors.lastname: Zhou
authors.forename: Eric Q
authors.initials: EQ
authors.lastname: Wu
authors.forename: Chad
authors.initials: C
authors.lastname: Patel
authors.forename: David L
authors.initials: DL
authors.lastname: Horn
mesh_terms: D000328:Adult; D000666:Amphotericin B / Q000191:economics* / Q000627:therapeutic use; D000935:Antifungal Agents / Q000191:economics / Q000627:therapeutic use; D001230:Aspergillus / Q000187:drug effects / Q000472:pathogenicity; D002175:Candida / Q000187:drug effects / Q000472:pathogenicity; D003365:Costs and Cost Analysis; D003454:Cryptococcus / Q000187:drug effects / Q000472:pathogenicity; D016527:Drug Costs; D025141:Drug Resistance, Fungal; D006801:Humans; D016867:Immunocompromised Host; D008954:Models, Biological; D009181:Mycoses / Q000188:drug therapy / Q000191:economics*; D014481:United States
chemical_list: D000935:Antifungal Agents; C068538:liposomal amphotericin B; D000666:Amphotericin B