title: Economic analysis of empiric versus diagnostic-driven strategies for immunocompromised patients with suspected fungal infections in the People's Republic of China.
abstract: Invasive fungal infections (IFIs) require rapid diagnosis and treatment. A decision-analytic model was used to estimate total costs and survival associated with a diagnostic-driven (DD) or an empiric treatment approach in neutropenic patients with hematological malignancies receiving chemotherapy or autologous/allogeneic stem cell transplants in Shanghai, Beijing, Chengdu, and Guangzhou, the People's Republic of China. Treatment initiation for the empiric approach occurred after clinical suspicion of an IFI; treatment initiation for the DD approach occurred after clinical suspicion and a positive IFI diagnostic test result. Model inputs were obtained from the literature; treatment patterns and resource use were based on clinical opinion. Total costs were lower for the DD versus the empiric approach in Shanghai (¥3,232 vs ¥4,331), Beijing (¥3,894 vs ¥4,864), Chengdu, (¥4,632 vs ¥5,795), and Guangzhou (¥8,489 vs ¥9,795). Antifungal administration was lower using the DD (5.7%) than empiric (9.8%) approach, with similar survival rates. Results from one-way and probabilistic sensitivity analyses were most sensitive to changes in diagnostic test sensitivity and IFI incidence; the DD approach dominated the empiric approach in 88% of scenarios. These results suggest that a DD compared to an empiric treatment approach in the People's Republic of China may be cost saving, with similar overall survival in immunocompromised patients with suspected IFIs.
authors.affiliation: School of International Pharmaceutical Business, China Pharmaceutical University, Nanjing, People's Republic of China.
authors.forename: Ningying
authors.initials: N
authors.lastname: Mao
authors.affiliation: Pharmerit International, Bethesda, MD, USA.
authors.forename: Beth
authors.initials: B
authors.lastname: Lesher
authors.affiliation: Hematology Department, Nanfang Hospital, Southern Medical University, Guangzhou, People's Republic of China.
authors.forename: Qifa
authors.initials: Q
authors.lastname: Liu
authors.affiliation: Pharmerit International, Bethesda, MD, USA.
authors.forename: Lei
authors.initials: L
authors.lastname: Qin
authors.affiliation: Pfizer Investment Co. Ltd., Beijing, People's Republic of China.
authors.forename: Yixi
authors.initials: Y
authors.lastname: Chen
authors.affiliation: Pharmerit International, Bethesda, MD, USA.
authors.forename: Xin
authors.initials: X
authors.lastname: Gao
authors.affiliation: RTI Health Solutions, Research Triangle Park, NC, USA.
authors.forename: Stephanie R
authors.initials: SR
authors.lastname: Earnshaw
authors.affiliation: RTI Health Solutions, Research Triangle Park, NC, USA.
authors.forename: Cheryl L
authors.initials: CL
authors.lastname: McDade
authors.affiliation: Pfizer International Operations, Paris, France.
authors.forename: Claudie
authors.initials: C
authors.lastname: Charbonneau
keywords: aspergillosis; caspofungin; cost-effectiveness analysis; itraconazole; voriconazole