A cost-effectiveness analysis comparing two approaches for empirical antifungal therapy in hematological patients with persistent febrile neutropenia.
Antimicrob Agents Chemother. 2013 Jul 15;
Authors: Martín-Peña A, Gil-Navarro MV, Aguilar-Guisado M, Espigado I, Ruiz Pérez de Pipaón M, Falantes J, Pachón J, Cisneros JM
Abstract
New approaches of empirical antifungal therapy (EAT) in selected hematological patients with persistent febrile neutropenia (PFN) have been proposed in recent years, but their cost-effectiveness have not been studied. The aim of this study is to compare the cost-effectiveness of two different approaches of EAT in hematological patients with PFN: diagnostic driven antifungal therapy (DDAT) approach versus standard approach of EAT. A decision-tree to assess the cost-effectiveness of both approaches was developed. Outcome probabilities and treatment pathways were extrapolated from two studies: a prospective cohort study following the DDAT approach and a randomized clinical trial following the standard approach. Uncertainty was undertaken through sensitivity analyses and Monte Carlo simulation.The average effectiveness and economic advantages in the DDAT approach compared to the standard approach were 2.6% and €5,879 (33%) per PFN episode, respectively. The DDAT was the dominant approach in the 99.5% of the simulations performed with average cost-effectiveness per PFN episode of €32,671 versus €52,479 in the EAT approach. The results were robust over a wide range of variables.The diagnostic driven antifungal therapy approach is more cost-effective than the empirical antifungal therapy approach in the management of persistent febrile neutropenia in hematological patients.
PMID: 23856767 [PubMed - as supplied by publisher]