title: A cost and resource utilization analysis of micafungin bridging for hemato-oncological high-risk patients undergoing allogeneic stem cell transplantation.
abstract: BACKGROUND
  Intravenous bridging strategies increase exposure of antifungal prophylaxis in high-risk hematological patients. The cost-effectiveness of such strategies has not been analyzed.
  
  
  METHODS
  A recent study compared the impact of oral posaconazole (POS) and oral posaconazole with intravenous micafungin bridging (POS-MIC) as prophylactic antifungal regimens in patients undergoing allogeneic stem cell transplantation (aSCT). Based on data from the Cologne Cohort of Neutropenic Patients (CoCoNut), a health economic evaluation of direct treatment costs was performed to analyze the economic impact of micafungin bridging. Analysis was undertaken based on current guidelines for the German societal perspective with an annual discount rate of 5%, whereby indirect costs were disregarded due to the severity of the underlying disease. Sensitivity analysis of cost calculation with different discount rates was performed to improve robustness of our health economic evaluation.
  
  
  RESULTS
  A retrospective case-control analysis of patients undergoing aSCT between 05/2006 and 07/2011 was performed; 106 patients each in the POS and POS-MIC group were included. In the POS and POS-MIC group, mean costs per patient for the treatment on bone marrow transplant ward were €27,228 (95% CI: €24,932-€29,525) vs. €27,894 (95% CI: €26,414-€29,375; P = 0.629), for diagnostic measures €2124 (95% CI: €1823-€2425) vs. €1269 (95% CI: €1168-€1370; P ≤ 0.001), for laboratory findings €10,612 (95% CI: €9681-€11,544) vs. €8836 (95% CI: €8198-€9475; P = 0.002), and for overall antifungal treatment €6105 (95% CI: €4703-€7508) vs. €6943 (95% CI: €5393-€8493; P = 0.428), resulting in mean overall costs per patient of €60,304 (95% CI: €53,969-€66,639) vs. €58,089 (95% CI: €51,736-64,442; P = 0.625).
  
  
  CONCLUSIONS
  Our health economic evaluation shows micafungin bridging in aSCT patients did not result in excess cost. Higher acquisition costs of antifungal prophylaxis were balanced by a reduced incidence of possible IFD and lower costs for empirical, preemptive, and targeted antifungal therapy as well as lower costs for diagnostic measures and laboratory tests in the micafungin bridging group.
authors.affiliation: 1st Department of Internal Medicine, University Hospital of Cologne, Cologne, Germany.
authors.forename: Sebastian M
authors.initials: SM
authors.lastname: Heimann
authors.affiliation: 1st Department of Internal Medicine, University Hospital of Cologne, Cologne, Germany.|German Centre for Infection Research, Partner Site Bonn-Cologne, Cologne, Germany.
authors.forename: Maria J G T
authors.initials: MJ
authors.lastname: Vehreschild
authors.affiliation: 1st Department of Internal Medicine, University Hospital of Cologne, Cologne, Germany.|Clinical Trials Centre Cologne, ZKS Köln (BMBF01KN1106), University Hospital of Cologne, Cologne, Germany.|Cluster of Excellence - Cellular Stress Responses in Aging-Associated Diseases, CECAD, University of Cologne, Cologne, Germany.|Center for Integrated Oncology Köln Bonn, CIO Köln Bonn, University Hospital of Cologne, Cologne, Germany.
authors.forename: Oliver A
authors.initials: OA
authors.lastname: Cornely
authors.affiliation: 1st Department of Internal Medicine, University Hospital of Cologne, Cologne, Germany.
authors.forename: Bernd
authors.initials: B
authors.lastname: Franke
authors.affiliation: 1st Department of Internal Medicine, University Hospital of Cologne, Cologne, Germany.|Center for Integrated Oncology Köln Bonn, CIO Köln Bonn, University Hospital of Cologne, Cologne, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: von Bergwelt-Baildon
authors.affiliation: Institute for Medical Microbiology, Immunology and Hygiene, University Hospital of Cologne, Cologne, Germany.
authors.forename: Hilmar
authors.initials: H
authors.lastname: Wisplinghoff
authors.affiliation: 1st Department of Internal Medicine, University Hospital of Cologne, Cologne, Germany.
authors.forename: Florian
authors.initials: F
authors.lastname: Kron
authors.affiliation: 1st Department of Internal Medicine, University Hospital of Cologne, Cologne, Germany.
authors.forename: Christoph
authors.initials: C
authors.lastname: Scheid
authors.affiliation: 1st Department of Internal Medicine, University Hospital of Cologne, Cologne, Germany.|German Centre for Infection Research, Partner Site Bonn-Cologne, Cologne, Germany.
authors.forename: Jörg J
authors.initials: JJ
authors.lastname: Vehreschild
mesh_terms: D000935:Antifungal Agents / Q000008:administration & dosage / Q000191:economics / Q000627:therapeutic use*; D016022:Case-Control Studies; D003362:Cost-Benefit Analysis; D003365:Costs and Cost Analysis; D054714:Echinocandins / Q000008:administration & dosage / Q000191:economics / Q000627:therapeutic use*; D005858:Germany; D017048:Health Care Costs; D019337:Hematologic Neoplasms / Q000150:complications* / Q000628:therapy; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects; D006801:Humans; D055666:Lipopeptides / Q000008:administration & dosage / Q000191:economics / Q000627:therapeutic use*; D000077551:Micafungin; D009181:Mycoses / Q000209:etiology* / Q000517:prevention & control*; D065129:Pre-Exposure Prophylaxis / Q000191:economics; D012189:Retrospective Studies
chemical_list: D000935:Antifungal Agents; D054714:Echinocandins; D055666:Lipopeptides; D000077551:Micafungin
keywords: allogeneic stem cell transplantation; antifungal prophylaxis; cost analysis; micafungin