Economic evaluation of intravenous itraconazole for presumed systemic fungal infections in neutropenic patients in Korea

Systemic fungal infections remain a major clinical problem in immunocompromised patients. Presumed systemic fungal infections (PSFI) are treated empirically with an intravenous antifungal agent to reduce the occurrence of documented infections and associated mortality. The objective of this study wa...

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Bibliographic Details
Published in:International journal of hematology 2005-10, Vol.82 (3), p.251-258
Main Authors: MOEREMANS, K, ANNEMANS, L, RYU, Ji-So, CHOE, Kang-Won, SHINE, Wan-Shik
Format: Article
Language:English
Subjects:
Amphotericin B - administration & dosage
Amphotericin B - economics
Antifungal Agents - administration & dosage
Antifungal Agents - economics
Biological and medical sciences
Costs and Cost Analysis
Hematologic and hematopoietic diseases
Humans
Immunodeficiencies
Immunodeficiencies. Immunoglobulinopathies
Immunopathology
Itraconazole - administration & dosage
Itraconazole - economics
Korea
Medical sciences
Mycoses - complications
Mycoses - drug therapy
Mycoses - economics
Neoplasms - complications
Neoplasms - economics
Neoplasms - therapy
Neutropenia - complications
Neutropenia - economics
Neutropenia - etiology
Other diseases. Hematologic involvement in other diseases
Randomized Controlled Trials as Topic
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Summary:Systemic fungal infections remain a major clinical problem in immunocompromised patients. Presumed systemic fungal infections (PSFI) are treated empirically with an intravenous antifungal agent to reduce the occurrence of documented infections and associated mortality. The objective of this study was to compare the cost-effectiveness of intravenous itraconazole (IVitra) treatment with the current first-line empirical treatment of PSFI with conventional amphotericin B (CAB) in cases of neutropenic cancer and bone marrow transplantation (BMT). Cost-effectiveness was expressed as cost per additional "responder" (defined as a patient without fever or major toxicity). We developed a medical decision analytical tree that included probabilities of toxicity, response and pathogen documentation, and second-line treatments. Clinical data were obtained from randomized clinical trials, and resource use data were obtained from a panel of clinical experts. The total cost of treating PSFI per neutropenic cancer patient was lower for IVitra than for CAB, and this lower cost resulted from a reduced need for second-line antifungals. In a cost-effectiveness analysis, IVitra treatment was superior to CAB treatment. Compared with current treatment with CAB, IVitra therapy was shown to be a cost-effective and cost-saving empirical treatment for PSFI in neutropenic cancer patients and BMT patients.
ISSN:0925-5710
1865-3774
DOI:10.1532/IJH97.A30504