title: Aerosolised liposomal amphotericin B to prevent aspergillosis in acute myeloid leukaemia: Efficacy and cost effectiveness in real-life.
abstract: Chemotherapy-induced neutropenia can be complicated by invasive pulmonary aspergillosis (IPA). In 2008, liposomal amphotericin B (L-AmB) inhalation was shown to prevent IPA in a placebo-controlled trial. Patients with acute myeloid leukaemia (AML) are the subset of haematology patients at high risk for IPA. In 2008, L-AmB inhalation prophylaxis became the standard of care for all AML patients in Erasmus MC. In this study, the efficacy and cost effectiveness of L-AmB inhalation were evaluated in a prospective cohort of AML patients. In total, 127 consecutive AML patients received chemotherapy and prophylactically inhaled L-AmB during their first and second chemotherapy cycles; 108 patients treated for AML at the same sites from 2005-2008 served as controls. A standardised diagnostic protocol was used and probable/proven IPA served as the primary endpoint. Diagnostic and therapeutic costs were also comprehensively analysed and compared. A significant decrease in probable/proven IPA in the L-AmB inhalation group was observed (L-AmB 9.5% vs. controls 23.4%; P=0.0064). Systemic antifungal therapy given at any time during the entire AML therapy decreased from 52.8% to 29.9%. Per-patient equipment and drug costs for L-AmB inhalation (1292 €/patient) were more than compensated for by a decrease in costs for diagnostics and therapeutic voriconazole use (-1816 €/patient). No serious adverse events related to L-AmB inhalation were observed. In an unselected AML patient group, L-AmB inhalation resulted in a significant and substantial decrease in IPA and was cost saving. Now that azole resistance is more frequent, non-azole-based prophylaxis may become an attractive strategy.
authors.affiliation: Department of Haematology, Erasmus University Medical Center, PB 2040, 3000CA Rotterdam, The Netherlands; Department of Internal Medicine, Section of Infectious Diseases, Erasmus University Medical Center, PB 2040, 3000CA Rotterdam, The Netherlands.
authors.forename: Ga-Lai M
authors.initials: GL
authors.lastname: Chong
authors.affiliation: Department of Internal Medicine, Section of Infectious Diseases, Erasmus University Medical Center, PB 2040, 3000CA Rotterdam, The Netherlands.
authors.forename: Fleur
authors.initials: F
authors.lastname: Broekman
authors.affiliation: Department of Public Health, Erasmus University Medical Center, PB 2040, 3000CA Rotterdam, The Netherlands.
authors.forename: Suzanne
authors.initials: S
authors.lastname: Polinder
authors.affiliation: Department of Haematology, Erasmus University Medical Center, PB 2040, 3000CA Rotterdam, The Netherlands.
authors.forename: Jeanette K
authors.initials: JK
authors.lastname: Doorduijn
authors.affiliation: Department of Haematology, Erasmus University Medical Center, PB 2040, 3000CA Rotterdam, The Netherlands.
authors.forename: Pieternella J
authors.initials: PJ
authors.lastname: Lugtenburg
authors.affiliation: Department of Internal Medicine, Section of Infectious Diseases, Erasmus University Medical Center, PB 2040, 3000CA Rotterdam, The Netherlands.
authors.forename: Annelies
authors.initials: A
authors.lastname: Verbon
authors.affiliation: Department of Haematology, Erasmus University Medical Center, PB 2040, 3000CA Rotterdam, The Netherlands.
authors.forename: Jan J
authors.initials: JJ
authors.lastname: Cornelissen
authors.affiliation: Department of Internal Medicine, Section of Infectious Diseases, Erasmus University Medical Center, PB 2040, 3000CA Rotterdam, The Netherlands. Electronic address: b.rijnders@erasmusmc.nl.
authors.forename: Bart J A
authors.initials: BJ
authors.lastname: Rijnders
mesh_terms: D000280:Administration, Inhalation; D000328:Adult; D000336:Aerosols / Q000008:administration & dosage* / Q000009:adverse effects / Q000191:economics; D000368:Aged; D000666:Amphotericin B / Q000008:administration & dosage* / Q000009:adverse effects / Q000191:economics; D000935:Antifungal Agents / Q000008:administration & dosage* / Q000009:adverse effects / Q000191:economics; D001228:Aspergillosis / Q000191:economics / Q000517:prevention & control*; D018890:Chemoprevention / Q000009:adverse effects / Q000191:economics / Q000379:methods*; D003362:Cost-Benefit Analysis; D003955:Diagnostic Tests, Routine / Q000191:economics / Q000379:methods; D064420:Drug-Related Side Effects and Adverse Reactions / Q000453:epidemiology / Q000473:pathology; D005260:Female; D006801:Humans; D015470:Leukemia, Myeloid, Acute / Q000150:complications*; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D011446:Prospective Studies; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000336:Aerosols; D000935:Antifungal Agents; C068538:liposomal amphotericin B; D000666:Amphotericin B
keywords: Aerosolised liposomal amphotericin B; Cost effectiveness; Inhalation; Invasive pulmonary aspergillosis; Prophylaxis