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Shibata Y, Miyahara Y, Sadaka Y, Yasue M, Fujimura M, Soda M, Yamamoto M, Kato H, Suzuki A, Tsukamoto K, Hara T, Tsurumi H, Kitaichi K. Evaluation of the effectiveness of caspofungin against febrile neutropenia and the factors related to the alteration in its plasma concentration. J Infect Chemother 2019; 25:801-805. [PMID: 31047782 DOI: 10.1016/j.jiac.2019.04.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2019] [Revised: 03/29/2019] [Accepted: 04/15/2019] [Indexed: 10/26/2022]
Abstract
Caspofungin (CPFG) is an echinocandin antifungal agent that inhibits the synthesis of β-1, 3-D-glucan, a critical component of the cell wall of target fungi. Several clinical studies have confirmed the efficacy and safety of CPFG in patients with febrile neutropenia (FN); however, there are no reports available in Japanese patients with FN. Therefore, we investigated the therapeutic efficacy and pharmacokinetics of CPFG as an empirical therapy in a Japanese hospital. Twenty-four Japanese patients, who were diagnosed with FN at Gifu University Hospital from February 2014 to August 2017, were enrolled. Blood samples were collected at the end of CPFG dosing (0.5 h after the infusion) on day 1 and immediately prior to the next infusion on days 2, 3, and 4. The concentration of CPFG in plasma was measured by high-performance liquid chromatography. The efficacy was assessed by five of the component endpoints, and safety was monitored according to the Common Terminology Criteria for Adverse Events. CPFG showed an excellent effect against FN (75%, 18/24), without any serious hepatic or renal toxicity. Regarding the pharmacokinetics, the plasma concentration of CPFG was significantly correlated with body weight; although, no correlation was observed between the plasma concentration of CPFG and the other factors investigated, such as gender or laboratory results. These results suggest the high efficacy, safety, and tolerability of CPFG as an empirical antifungal therapy for Japanese patients with FN.
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Affiliation(s)
- Yuhei Shibata
- Department of Hematology, Gifu University Graduate School of Medicine, 1-1 Yanagido, Gifu, 501-1194, Japan; Department of Hematology, Gifu Municipal Hospital, 7-1 Kashima-cho, Gifu, 500-8513, Japan
| | - Yuri Miyahara
- Laboratory of Pharmaceutics, Gifu Pharmaceutical University, 1-25-4 Daigakunishi, Gifu, 501-1196, Japan
| | - Yuna Sadaka
- Laboratory of Pharmaceutics, Gifu Pharmaceutical University, 1-25-4 Daigakunishi, Gifu, 501-1196, Japan
| | - Mika Yasue
- Laboratory of Pharmaceutics, Gifu Pharmaceutical University, 1-25-4 Daigakunishi, Gifu, 501-1196, Japan
| | - Minami Fujimura
- Laboratory of Pharmaceutics, Gifu Pharmaceutical University, 1-25-4 Daigakunishi, Gifu, 501-1196, Japan
| | - Midori Soda
- Laboratory of Pharmaceutics, Gifu Pharmaceutical University, 1-25-4 Daigakunishi, Gifu, 501-1196, Japan
| | - Miho Yamamoto
- Global Regulatory Science, Gifu Pharmaceutical University, 1-25-4 Daigakunishi, Gifu, 501-1196, Japan
| | - Hiroko Kato
- Department of Pharmacy, Gifu University Hospital, 1-1 Yanagido, Gifu 501-1194, Japan
| | - Akio Suzuki
- Department of Pharmacy, Gifu University Hospital, 1-1 Yanagido, Gifu 501-1194, Japan
| | - Katsura Tsukamoto
- Global Regulatory Science, Gifu Pharmaceutical University, 1-25-4 Daigakunishi, Gifu, 501-1196, Japan
| | - Takeshi Hara
- Department of Hematology, Gifu University Graduate School of Medicine, 1-1 Yanagido, Gifu, 501-1194, Japan; Department of Hematology, Matsunami General Hospital, Dendai 185-1, Kasamatsu-cho, Hasima-gun, Gifu, 501-6062, Japan
| | - Hisashi Tsurumi
- Department of Hematology, Gifu University Graduate School of Medicine, 1-1 Yanagido, Gifu, 501-1194, Japan; Department of Hematology, Matsunami General Hospital, Dendai 185-1, Kasamatsu-cho, Hasima-gun, Gifu, 501-6062, Japan
| | - Kiyoyuki Kitaichi
- Laboratory of Pharmaceutics, Gifu Pharmaceutical University, 1-25-4 Daigakunishi, Gifu, 501-1196, Japan.
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Chen K, Wang Q, Pleasants RA, Ge L, Liu W, Peng K, Zhai S. Empiric treatment against invasive fungal diseases in febrile neutropenic patients: a systematic review and network meta-analysis. BMC Infect Dis 2017; 17:159. [PMID: 28219330 PMCID: PMC5319086 DOI: 10.1186/s12879-017-2263-6] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Accepted: 02/11/2017] [Indexed: 02/07/2023] Open
Abstract
Background The most optimal antifungal agent for empiric treatment of invasive fungal diseases (IFDs) in febrile neutropenia is controversial. Our objective was evaluate the relative efficacy of antifungals for all-cause mortality, fungal infection-related mortality and treatment response in this population. Methods Pubmed, Embase and Cochrane Library were searched to identify randomized controlled trials (RCTs). Two reviewers performed the quality assessment and extracted data independently. Pairwise meta-analysis and network meta-analysis were conducted to compare the antifungals. Results Seventeen RCTs involving 4583 patients were included. Risk of bias of included studies was moderate. Pairwise meta-analysis indicated the treatment response rate of itraconazole was significantly better than conventional amphotericin B (RR = 1.33, 95%CI 1.10–1.61). Network meta-analysis showed that amphotericin B lipid complex, conventional amphotericin B, liposomal amphotericin B, itraconazole and voriconazole had a significantly lower rate of fungal infection-related mortality than no antifungal treatment. Other differences in outcomes among antifungals were not statistically significant. From the rank probability plot, caspofungin appeared to be the most effective agent for all-cause mortality and fungal infection-related mortality, whereas micafungin tended to be superior for treatment response. The results were stable after excluding RCTs with high risk of bias, whereas micafungin had the lowest fungal infection-related mortality. Conclusions Our results highlighted the necessity of empiric antifungal treatment and indicates that echinocandins appeared to be the most effective agents for empiric treatment of febrile neutropenic patients based on mortality and treatment response. However, more studies are needed to determine the best antifungal agent for empiric treatment. Our systematic review has been prospectively registered in PROSPERO and the registration number was CRD42015026629. Electronic supplementary material The online version of this article (doi:10.1186/s12879-017-2263-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Ken Chen
- Department of Pharmacy, Peking University Third Hospital, Beijing, 100191, China
| | - Qi Wang
- Evidence Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, 730000, China
| | - Roy A Pleasants
- Duke University Division of Pulmonary, Allergy, and Critical Care Medicine, Duke University School of Medicine, Durham, NC, 27705, USA
| | - Long Ge
- Evidence Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, 730000, China
| | - Wei Liu
- Department of Pharmacy, Peking University Third Hospital, Beijing, 100191, China
| | - Kangning Peng
- School of Basic Medical Sciences, Peking University Health Science Center, Beijing, 100191, China
| | - Suodi Zhai
- Department of Pharmacy, Peking University Third Hospital, Beijing, 100191, China.
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Mistro S, Rosa L, Gomes B, Miranda L, Badaró R. Cost-effectiveness of caspofungin versus liposomal amphotericin B in the treatment of systemic fungal infections: a systematic review of economic analyses. Expert Rev Pharmacoecon Outcomes Res 2016; 16:465-73. [DOI: 10.1080/14737167.2016.1202766] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Current applications of nanoparticles in infectious diseases. J Control Release 2016; 224:86-102. [PMID: 26772877 DOI: 10.1016/j.jconrel.2016.01.008] [Citation(s) in RCA: 234] [Impact Index Per Article: 29.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2015] [Revised: 01/03/2016] [Accepted: 01/05/2016] [Indexed: 02/06/2023]
Abstract
For decades infections have been treated easily with drugs. However, in the 21st century, they may become lethal again owing to the development of antimicrobial resistance. Pathogens can become resistant by means of different mechanisms, such as increasing the time they spend in the intracellular environment, where drugs are unable to reach therapeutic levels. Moreover, drugs are also subject to certain problems that decrease their efficacy. This requires the use of high doses, and frequent administrations must be implemented, causing adverse side effects or toxicity. The use of nanoparticle systems can help to overcome such problems and increase drug efficacy. Accordingly, there is considerable current interest in their use as antimicrobial agents against different pathogens like bacteria, virus, fungi or parasites, multidrug-resistant strains and biofilms; as targeting vectors towards specific tissues; as vaccines and as theranostic systems. This review begins with an overview of the different types and characteristics of nanoparticles used to deliver drugs to the target, followed by a review of current research and clinical trials addressing the use of nanoparticles within the field of infectious diseases.
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Turner SJ, Senol E, Kara A, Al-Badriyeh D, Dinleyici EC, Kong DCM. Cost effectiveness of caspofungin vs. voriconazole for empiric therapy in Turkey. Mycoses 2014; 57:489-96. [PMID: 24635908 DOI: 10.1111/myc.12187] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2013] [Revised: 02/19/2014] [Accepted: 02/20/2014] [Indexed: 11/29/2022]
Abstract
Invasive fungal infections from febrile neutropenia are associated with significant cost and mortality. The mainstay of treatment has been liposomal amphotericin B, however, echinocandins and azoles have shown promise as alternative treatments. Data on clinical efficacy exist, however, data incorporating pharmacoeconomic considerations are required in Turkey. The aim of this study was to investigate the cost effectiveness of caspofungin vs. voriconazole in empiric treatment of febrile neutropenia in Turkey. A decision analytic model was utilised, built upon two randomised-controlled trials and supplemented with expert panel input from clinicians in Turkey. A five-point composite outcome measure was utilised and sensitivity analyses were performed to demonstrate the robustness of the model. The base case scenario resulted in caspofungin being preferred by TL2,533, TL29,256 and TL2,536 per patient treated, successfully treated patient and patient survival, respectively (approx. USD1414, 16 328 and 1415); sensitivity analyses did not change the outcome. Monte Carlo simulation highlighted a 78.8% chance of favouring caspofungin. The result was moderately sensitive to treatment duration and acquisition cost of the antifungal agents compared. This is the first pharmacoeconomic study comparing caspofungin to voriconazole within Turkey, resulting in an advantage towards caspofungin. The study will aid in formulary decision-making based on the clinical and economic consequences of each agent in the Turkish health care setting.
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Affiliation(s)
- S J Turner
- Department of Pharmacy Practice and Administration, Ernest Mario School of Pharmacy, Rutgers University, Piscataway, NJ, USA
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Turner SJ, Chen SCA, Slavin MA, Kong DCM. Pharmacoeconomics of empirical antifungal use in febrile neutropenic hematological malignancy and hematopoietic stem cell transplant patients. Expert Rev Pharmacoecon Outcomes Res 2014; 13:227-35. [DOI: 10.1586/erp.13.3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Turner SJ, Senol E, Kara A, Al-Badriyeh D, Dinleyici EC, Kong DC. Pharmacoeconomic evaluation of voriconazole vs. liposomal amphotericin B in empiric treatment of invasive fungal infections in Turkey. BMC Infect Dis 2013; 13:560. [PMID: 24279677 PMCID: PMC4222893 DOI: 10.1186/1471-2334-13-560] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2013] [Accepted: 11/21/2013] [Indexed: 11/20/2022] Open
Abstract
Background Invasive fungal infections (IFI) are associated with considerable expense and mortality on healthcare systems. There is a need to provide evidence of both clinical efficacy and value for money with any health technology. The current pharmacoeconomic evaluation investigated the use of liposomal amphotericin B (LAmB) and voriconazole for the empiric treatment of IFI in the Turkish setting. Methods Decision analytic modelling was used to create a pathway for patient treatment with a 5-point composite outcome measure. The data was obtained from a major non-inferiority multicentre randomised controlled study, with an expert panel of clinicians in Turkey providing transition probabilities and cost not available in the literature. Sensitivity analyses were performed on the inputs from the clinical trial and the expert panel. Results As per the base case analysis, voriconazole was preferred by Turkish Lira (TL) 2,523 per patient treated and TL2,520 per surviving patient. LAmB was the preferred alternative by TL5,362 per successfully treated patient. Removing fever resolution as part of the composite outcome measure resulted in voriconazole being the preferred alternative per successfully treated patient. Univariate sensitivity analysis highlighted that increasing the duration of voriconazole by >1.2 days or decreasing LAmB by >1.0 days changes the result. Monte Carlo Simulation resulted in 69.4% of simulations favouring voriconazole per patient treated. Conclusion There is a strong likelihood that voriconazole is economically more favourable than LAmB in the empiric treatment of IFI in Turkey.
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Affiliation(s)
- Stuart J Turner
- Department of Pediatrics, Pediatric Intensive Care and Pediatric Infectious Disease, Faculty of Medicine, Eskisehir Osmangazi University, Eskisehir 26480, Turkey.
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Cost-effectiveness of anidulafungin in confirmed candidaemia and other invasive Candida infections in Spain. J Mycol Med 2013; 23:155-63. [DOI: 10.1016/j.mycmed.2013.05.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2012] [Revised: 04/19/2013] [Accepted: 05/15/2013] [Indexed: 11/16/2022]
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Turner S, Senol E, Kara A, Al-Badriyeh D, Kong D, Dinleyici E. Pharmacoeconomic evaluation of caspofungin versus liposomal amphotericin B in empirical treatment of invasive fungal infections in Turkey. Int J Antimicrob Agents 2013; 42:276-80. [DOI: 10.1016/j.ijantimicag.2013.04.030] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2013] [Revised: 04/29/2013] [Accepted: 04/30/2013] [Indexed: 10/26/2022]
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Cost-effectiveness analysis comparing two approaches for empirical antifungal therapy in hematological patients with persistent febrile neutropenia. Antimicrob Agents Chemother 2013; 57:4664-72. [PMID: 23856767 DOI: 10.1128/aac.00723-13] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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 has not been studied. The aim of this study was to compare the cost-effectiveness of two different approaches of EAT in hematological patients with PFN: the diagnosis-driven antifungal therapy (DDAT) approach versus the 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 DDAT approach is more cost-effective than the EAT approach in the management of PFN in hematological patients.
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Neoh CF, Liew D, Slavin MA, Marriott D, Chen SCA, Morrissey O, Stewart K, Kong DCM. Economic evaluation of micafungin versus caspofungin for the treatment of candidaemia and invasive candidiasis. Intern Med J 2013; 43:668-77. [DOI: 10.1111/imj.12110] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2012] [Accepted: 02/20/2013] [Indexed: 11/30/2022]
Affiliation(s)
| | - D. Liew
- Melbourne EpiCentre; Department of Medicine; University of Melbourne, Royal Melbourne Hospital; Australia
| | - M. A Slavin
- Department of Infectious Diseases; Peter MacCallum Cancer Centre; Australia
| | - D. Marriott
- Department of Clinical Microbiology and Infectious Diseases; St Vincent's Hospital; Sydney; Australia
| | - S. C.-A. Chen
- Centre for Infectious Diseases and Microbiology; Westmead Hospital; Sydney; New South Wales; Australia
| | - O. Morrissey
- Infectious Diseases Unit; Department of Medicine; Alfred Health and Monash University; Melbourne; Victoria; Australia
| | - K. Stewart
- Centre for Medicine Use and Safety; Faculty of Pharmacy and Pharmaceutical Sciences; Monash University (Parkville campus); Australia
| | - D. C. M. Kong
- Centre for Medicine Use and Safety; Faculty of Pharmacy and Pharmaceutical Sciences; Monash University (Parkville campus); Australia
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Neoh CF, Liew D, Slavin MA, Marriott D, Chen SCA, Morrissey O, Stewart K, Kong DCM. Economic evaluation of micafungin vs. Liposomal Amphotericin B (LAmB) for the treatment of candidaemia and Invasive Candidiasis (IC). Mycoses 2013; 56:532-42. [DOI: 10.1111/myc.12071] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2012] [Revised: 01/17/2013] [Accepted: 02/21/2013] [Indexed: 11/25/2022]
Affiliation(s)
| | - Danny Liew
- Department of Medicine; Melbourne EpiCentre; University of Melbourne; Royal Melbourne Hospital; Parkville; Australia
| | - Monica A. Slavin
- Department of Infectious Diseases; Peter MacCallum Cancer Centre; East Melbourne; Australia
| | - Debbie Marriott
- Department of Clinical Microbiology and Infectious Diseases; St Vincent's Hospital; Darlinghurst; Australia
| | - Sharon C.-A. Chen
- Centre for Infectious Diseases and Microbiology; Westmead Hospital; Wentworthville; Australia
| | - Orla Morrissey
- Department of Medicine; Infectious Diseases Unit; Alfred Health and Monash University; Melbourne; Australia
| | - Kay Stewart
- Centre for Medicine Use and Safety; Faculty of Pharmacy and Pharmaceutical Sciences; Monash University (Parkville campus); Parkville; Australia
| | - David C. M. Kong
- Centre for Medicine Use and Safety; Faculty of Pharmacy and Pharmaceutical Sciences; Monash University (Parkville campus); Parkville; Australia
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Luong ML, Husain S, Rotstein C. Pharmacoeconomic assessment of therapy for invasive aspergillosis. Mycoses 2013; 56:338-49. [DOI: 10.1111/myc.12036] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Gamboa Garay OA, Fuentes Pachón JC, Cuervo Maldonado SI, Gómez Rincón JC, Castillo Londoño JS. Análisis de Costo Efectividad de Estrategias de Tratamiento Antimicótico en Pacientes con Neutropenia Febril Persistente y Tratamiento Antibiótico de Amplio Espectro. Value Health Reg Issues 2012; 1:201-210. [DOI: 10.1016/j.vhri.2012.09.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Treatment and prophylaxis of invasive candidiasis with anidulafungin, caspofungin and micafungin and its impact on use and costs: review of the literature. Eur J Med Res 2011; 16:180-6. [PMID: 21486732 PMCID: PMC3352074 DOI: 10.1186/2047-783x-16-4-180] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Invasive fungal infections are on the rise. Echinocandins are a relatively new class of antifungal drugs that act by inhibition of a key enzyme necessary for integrity of the fungal cell wall. Currently there are three available agents: caspofungin, micafungin and anidulafungin. While the individual echinocandin antifungals have a different spectrum of licensed indications, basically all of them are available for the treatment of candidemia and invasive candidiasis. Antifungal treatment modalities basically include in therapy for suspected or proven infection and prophylaxis. All three drugs are comparatively expensive. Therefore a systematic review of the literature was performed to investigate the following aspects: * General aspects of cost-effectiveness in the treatment of invasive fungal infections * Cost-effectiveness of the treatment with the above-mentioned antifungals * Cost-effectiveness in two settings: therapy and prophylaxis - Early initiation of antifungal therapy, adjustment after availability of microbiological results, duration of therapy, success and occurrence of severe complications (e.g. renal failure) are the most important cost drivers in antifungal therapy. - Considering the specific antifungals, for caspofungin the best evidence for cost-effectiveness is found in treatment of invasive candidiasis and in empiric therapy of suspected infections. Favourable economic data are available for micafungin as a cost-effective alternative to LAmB for prophylaxis in patients with hematopoietic stem cell transplantation (HSCT). For anidulafungin, cost-effectiveness was demostrated in a pharmacoeconomic model. Net savings - yet not significant - were observed in a retrospective chart review of 234 patients. Generally, however, most analyses are still based on pharmacoeconomic modelling rather than direct analysis of trial data or real-life clinical populations. - As an overall conclusion, using caspofungin, micafungin, or anidulafungin is not more expensive than using other established therapies. Micafungin has proven to be cost-effective in prophylaxis if the local fungal epidemiology indicates a high level of resistance to fluconazole. Switch strategies involving early initiation of broadly active therapy with switch to cheaper alternatives according to microbiology results and clinical status and early initiation of an appropriate therapy have been proven to be cost-efficient independent of the antifungal agent.
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Holt SL, Drew RH. Echinocandins: Addressing outstanding questions surrounding treatment of invasive fungal infections. Am J Health Syst Pharm 2011; 68:1207-20. [DOI: 10.2146/ajhp100456] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Neoh CF, Liew D, Slavin M, Marriott D, Chen SCA, Morrissey O, Stewart K, Kong DCM. Cost-effectiveness analysis of anidulafungin versus fluconazole for the treatment of invasive candidiasis. J Antimicrob Chemother 2011; 66:1906-15. [PMID: 21628305 DOI: 10.1093/jac/dkr186] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Anidulafungin was found to be non-inferior to and possibly more efficacious than fluconazole for treatment of invasive candidiasis (IC) in a major randomized clinical trial (RCT). There are no data comparing the cost-effectiveness between azoles and echinocandins in treating IC. This economic analysis investigated the cost-effectiveness of anidulafungin compared with fluconazole for treatment of IC in an Australian setting. METHODS A decision analytic model was constructed to capture downstream consequences of using either agent for treatment of IC. The main outcomes analysed in the model were treatment success and treatment failure (observed and indeterminate). Outcome probabilities and treatment pathways were derived from a published RCT. Resources used were estimated by an expert panel and cost inputs were derived from the latest Australian resources. The analysis was based on an Australian hospital perspective. Sensitivity analyses were conducted using Monte Carlo simulation. RESULTS Anidulafungin (AU$74,587) had a higher total cost than fluconazole (AU$60,945) per successfully treated patient, primarily due to its higher acquisition cost. Hospitalization was the main cost driver for both comparators. However, when the rates of mortality in both treatment arms were considered, treatment with anidulafungin was expected to save an additional 0.53 life-years, with an incremental cost-effectiveness ratio (ICER) of AU$25 740 per life-years saved, which was below the implicit ICER threshold value for Australia. The results were robust over a wide range of variables. CONCLUSIONS This is the first economic evaluation of anidulafungin versus fluconazole in the treatment of IC in Australia. Anidulafungin appears to be a cost-effective option.
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Affiliation(s)
- Chin Fen Neoh
- Department of Pharmacy Practice, Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, 381 Royal Parade, Parkville, Victoria 3052, Australia
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