title: Analysis of the efficiency and costs of antifungal prophylaxis and mycological diagnostics in patients undergoing allogeneic haematopoietic cell transplantation: "real life" evaluation.
abstract: Antifungal prophylaxis/therapy (AP/AT) raises the cost of allogeneic haematopoietic cell transplantation (alloHCT). Its efficacy, different approaches for AP/AT, diagnostic measures and cost-effectiveness must still be evaluated. In 2010, we conducted a prospective study with 106 consecutive patients receiving an alloHCT analysing AP/AT, choice and costs of diagnostics applied including CT scans, galactomannan (Gal) and β-D-glucan (β-D) testing. Antifungal prophylaxis in 91 patients consisted of fluconazole (FLU) or L-AMB (AmBisome™ 1 or 3 mg/kg/day b.w.), and antifungal therapy had to be initiated in 38 % of the FLU/L-AMB-1-mg patients but in none with L-AMB 3 mg. Empirical AT consisted of L-AMB 1 mg/kg (n = 12) and preemptive AT of L-AMB 3 mg/kg (n = 17) and proved very efficacious with no further antifungal drug escalation in 89.6 %. Mean costs of diagnostic measures were 402 €/alloHCT; however, only 22 % of the CT scans, 4 % of β-D and 3 % of galactomannan testing were positive. We detected one proven, 17 probable and 14 possible fungal infections. Due to the German diagnosis-related group system with additional compensation, all our AP/AT strategies were adequately reimbursed. While clinical symptoms and CT scans are the most commonly used, inexpensive decision-making tools for starting AT, the expensive laboratory diagnostic procedures are ineffective; we have therefore discontinued regular GAL/β-D testing and changed our AP in patients at risk.
authors.affiliation: Department of Haematology/Oncology/Stem Cell Transplantation, University Medical Center Freiburg, Hugstetter Street 55, 79106, Freiburg, Germany. hartmut.bertz@uniklinik-freiburg.de.
authors.forename: Hartmut
authors.initials: H
authors.lastname: Bertz
authors.affiliation: Department of Haematology/Oncology/Stem Cell Transplantation, University Medical Center Freiburg, Hugstetter Street 55, 79106, Freiburg, Germany.
authors.forename: Kathrin
authors.initials: K
authors.lastname: Drognitz
authors.affiliation: Department of Haematology/Oncology/Stem Cell Transplantation, University Medical Center Freiburg, Hugstetter Street 55, 79106, Freiburg, Germany.
authors.forename: Jürgen
authors.initials: J
authors.lastname: Finke
mesh_terms: D000328:Adult; D000368:Aged; D000935:Antifungal Agents / Q000008:administration & dosage* / Q000191:economics*; D003362:Cost-Benefit Analysis; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation / Q000191:economics* / Q000379:methods; D006801:Humans; D008297:Male; D008875:Middle Aged; D009181:Mycoses / Q000175:diagnosis* / Q000191:economics* / Q000628:therapy; D065129:Pre-Exposure Prophylaxis / Q000191:economics* / Q000379:methods; D011446:Prospective Studies; D019172:Transplantation Conditioning / Q000191:economics / Q000379:methods; D014184:Transplantation, Homologous / Q000191:economics / Q000379:methods; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000935:Antifungal Agents
keywords: Allogeneic HCT; Antifungal prophylaxis and therapy; Cost analysis