Pharmacoeconomic Analysis of Liposomal Amphotericin B Versus Conventional Amphotericin B in the Empirical Treatment of Persistently Febrile Neutropenic Patients

Cagnoni, Pablo J.; Walsh, Thomas J.; Prendergast, Mary M.; Bodensteiner, David; Hiemenz, Sharon; Greenberg, Richard N.; Arndt, Carola A.S.; Schuster, Mindy G.; Seibel, Nita L.; Yeldandi, Vijay; Tong, Karen A.

doi:10.1200/jco.2000.18.12.2476

Cited by 140 publications

(85 citation statements)

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“…An economic analysis of empirical antifungal therapy in persistently febrile neutropenic patients investigated to what degree savings associated with reduced nephrotoxicity could offset higher acquisition costs of the liposomal formulation (28). Despite a lower incidence of nephrotoxicity in the L-AMB group (19% for L-AMB versus 34% for CAB), overall hospital costs were significantly higher with L-AMB than with CAB (US$48,962 versus US$43,183, respectively).…”

Section: Discussionmentioning

confidence: 99%

An Economic Evaluation of Voriconazole versus Amphotericin B for the Treatment of Invasive Aspergillosis in Canada

Rotstein

Laverdière

Marciniak

et al. 2004

Canadian Journal of Infectious Diseases and Medical Microbiolog

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BACKGROUND: Invasive aspergillosis (IA) is a serious fungal infection that affects immunocompromised patients. The Global Comparative Aspergillosis study demonstrated that voriconazole, a new broad-spectrum triazole, had better responses and improved survival compared with conventional amphotericin B deoxycholate (CAB) and other licensed antifungal therapy (OLAT) for the treatment of definite or probable aspergillosis.OBJECTIVES: To compare costs and outcomes of voriconazole and CAB for the treatment of definite or probable aspergillosis in Canada.METHODS: A cost-consequence decision tree model was designed to reflect the treatment pathways used in clinical practice when using voriconazole or CAB as primary therapy for IA. Therapy included initial treatment with either voriconazole or CAB and then switched to an OLAT in the event of an inadequate response, severe toxicity or intolerance. The principal data source used was the Global Comparative Aspergillosis study.RESULTS: The total cost of voriconazole when compared with CAB as initial therapy for IA was $38,319 versus $42,495 per patient, respectively, representing a 9.8% cost reduction for each patient treated with voriconazole. The higher mean cost in the CAB arm was primarily due to the high proportion of patients (73.7%) who were switched to an OLAT due to severe side effects or an inadequate response. Treating with voriconazole was a dominant strategy. The number of patients that had to be treated with voriconazole instead of CAB to save one additional life was eight.CONCLUSIONS: Voriconazole as primary treatment for IA increased the chances of successful treatment, improved survival and may represent a potential cost saving strategy in Canada.

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Section: Discussionmentioning

confidence: 99%

An Economic Evaluation of Voriconazole versus Amphotericin B for the Treatment of Invasive Aspergillosis in Canada

Rotstein

Laverdière

Marciniak

et al. 2004

Canadian Journal of Infectious Diseases and Medical Microbiolog

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“…Il modello decisionale è stato quindi alimentato con opportuni valori di costo al fine di poter attuare l'analisi costo-efficacia nella prospettiva del SSN italiano, assumendo che i pazienti affetti da neutropenia febbrile venissero gestiti in ospedale per tutto il periodo del trattamento antifungino, secondo quanto rilevato negli studi di Wingard [32], ma con durate di degenza variabili in funzione della comparsa di nefrotossicità, secondo quanto rilevato nello studio di Cagnoni e collaboratori [33]. Inoltre abbiamo ipotizzato che, in caso di emodialisi, il trattamento potesse essere eseguito in regime di day-hospital.…”

Section: Stima Dei Costiunclassified

“…In caso di nefrotossicità senza ricorso ad emodialisi, abbiamo assunto che il costo giornaliero base della degenza ospedaliera aumentasse del 20%, secondo quanto stimato da Cagnoni et al [33].…”

Section: Stima Dei Costiunclassified

“…Si può tuttavia ritenere che vi sia una differenza clinicamente rilevante tra efficacia di ABLC 5mg/kg (33 A 9 1 , 7 6 2 . 2 3 8 , 2 8 6 6 , 3 0 7 .…”

Section: Analisi Costo-efficacia Incrementaleunclassified

“…Alcuni studi di farmacoeconomia hanno valutato l'incremento dei costi associato all'uso di tali preparati lipidici in sostituzione del prodotto standard cerando di indagare se i risparmi indotti con la riduzione degli effetti tossici potesse giustificare l'incremento del costo di acquisto [33,34].…”

Section: Introduzioneunclassified

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Analisi Costo-Efficacia di Amfotericina B Liposomiale (L-AmB) versus Amfotericina B Complesso Lipidico (ABLC) nel trattamento empirico della neutropenia febbrile

Eandi

2005

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Current international guidelines for the management of immuno-compromised patients with febrile neutropenia recommend a systemic antimicrobial therapy if fever hasn't receded after three days of antibiotic treatment. Amphotericin B remains the gold standard because of its broad spectrum fungicidal action and minimal resistance development risk. Nonetheless, therapeutic use of the standard formulation, Amphotericin B deoxycholate, is limited by its toxicity, especially on the kidneys. To counteract this, amphotericin B has been encapsulated in liposomes, a process which reduces its toxicity and allows higher doses to be given. Three lipid formulations have been developed and are now available in most countries: amB colloidal dispersion (ABCD), amB lipid complex (ABLC), and liposomal amB (L-AmB). These lipid formulations differ in pharmacodynamics and pharmacokinetics, and can't therefore be considered interchangeable. Besides, they are more expensive than Amphotericin B deoxycholate. Aim of the study is to perform a cost/effectiveness analysis (CEA) comparing L-AmB (3mg/kg/die or 5mg/kg/ die) and ABLC (5mg/kg/die) as first-line antimicrobial empirical treatments in immuno-compromised patients with febrile neutropenia resistant to broad spectrum antibiotics. Secondly, we present a cost-minimization analysis (CMA) of the considered alternatives, assuming the same efficacy for all treatments. At the end we value the principal cost items from the point of view of the Italian Health Service, with a particular focus on the economic burden caused by adverse reactions. REVIEW § Ordinario di Farmacologia Clinica, Università degli Studi di Torino INTRODUZIONELe attuali linee guida di gestione dei pazienti immmunodepressi in stato di neutropenia febbrile prevedono venga instaurata una terapia antimicotica sistemica nel caso in cui la febbre non regredisca dopo 3 giorni di terapia antibiotica [1][2][3][4].Infatti, nei pazienti neutropenici sono relativamente frequenti le infezioni o le co-infezioni micotiche invasive sostenute da Candida e da Aspergillus. Entrambe queste micosi sistemiche sono difficili da diagnosticare nei soggetti immunocompromessi, soprattutto nelle primi fasi dell'infezione, poiché le loro manifestazioni cliniche sono spesso scarsamente differenziabili da altri tipi di infezioni o da altre manifestazioni patologiche come le polmoniti da raggi e la GVHD [5][6][7].L'amfotericina B, per la sua elevata attività antimicotica nei confronti sia di Candida che di Aspergillus, è tuttora considerata il trattamento di riferimento per i pazienti con neutropenia febbrile che non rispondono alla terapia antibiotica ad ampio spettro. Tuttavia la sua formulazione tradizionale (amfotericina B desossicolato) presenta un profilo rischiobeneficio non molto favorevole a causa della elevata tossicità sistemica, principalmente renale, che ne limita l'uso a dosi subottimali che non consentono di ottenere il massimo beneficio terapeutico dalla molecola [8,9].Nel tentativo di superare questa difficoltà e migliorare l'ind...

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Amphotericin B lipid soluble formulations versus amphotericin B in cancer patients with neutropenia

Johansen

Gøtzsche

2000

Cochrane Database of Systematic Reviews

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Pharmacoeconomic Analysis of Liposomal Amphotericin B Versus Conventional Amphotericin B in the Empirical Treatment of Persistently Febrile Neutropenic Patients

Abstract: The cost of liposomal amphotericin B and patient risk for developing nephrotoxicity play large roles in determining whether liposomal amphotericin B is cost-effective as first-line empirical therapy in persistently febrile neutropenic patients.

Cited by 140 publications

References 4 publications

An Economic Evaluation of Voriconazole versus Amphotericin B for the Treatment of Invasive Aspergillosis in Canada

An Economic Evaluation of Voriconazole versus Amphotericin B for the Treatment of Invasive Aspergillosis in Canada

Analisi Costo-Efficacia di Amfotericina B Liposomiale (L-AmB) versus Amfotericina B Complesso Lipidico (ABLC) nel trattamento empirico della neutropenia febbrile

Amphotericin B lipid soluble formulations versus amphotericin B in cancer patients with neutropenia

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