Cost Effectiveness of Amphotericin B plus G-CSF Compared with Amphotericin B Monotherapy: Treatment of Presumed Deep-Seated Fungal Infection in Neutropenic Patients in the UK

Authors: Flynn T.N.¹; Kelsey S.M.²; Hazel D.L.²; Guest J.F.¹

Source: PharmacoEconomics, Volume 16, Number 5, November 1999 , pp. 543-550(8)

Publisher: Adis International

Abstract:

Objective: To assess the economic impact of adding granulocyte colony-stimulating factor (G-CSF) to amphotericin B to treat a presumed deep-seated fungal infection in neutropenic patients. This study was conducted from the perspective of the National Health Service (NHS) hospital sector.

Design: We used our previously reported trial as the clinical basis for the analysis (see Participants and interventions). These data were combined with resource utilisation data, enabling us to construct a decision tree model of the treatment paths attributable to managing patients in each arm of the trial. The model was used to calculate the cost effectiveness of using amphotericin B plus G-CSF compared to amphotericin B monotherapy in neutropenic patients with a presumed deep-seated fungal infection.

Setting: An adult leukaemia/bone marrow transplant (BMT) unit in a large UK teaching hospital.

Participants: Patients with a neutrophil count of <0.5 × 10/L and having a presumed deep-seated fungal infection after either chemotherapy or stem cell/bone marrow transplantation for haematological malignancy.

Interventions: 29 patients received intravenous amphotericin B (1 mg/kg daily) plus subcutaneous G-CSF (3 to 5 µg/kg daily) and 30 patients received intravenous amphotericin B (1 mg/kg daily) monotherapy. The clinical trial showed that 62% of patients responded to antifungal treatment with amphotericin B plus G-CSF compared to 33% of patients who responded to amphotericin B monotherapy (p = 0.027). Nonresponders went on to receive a lipid formulation of amphotericin B.

Main outcome measure and results: The mean cost per patient treated with amphotericin B plus G-CSF was £11 247 and the corresponding cost for amphotericin B monotherapy was £14 317 (1996/1997 values) - a cost reduction of £3070 per patient. Sensitivity analyses demonstrated that the addition of G-CSF to conventional amphotericin B in the treatment of a presumed deep-seated fungal infection offers not only clinical benefits, but cost benefits which are robust to changes in clinical and economic parameters.

Conclusion: From a UK hospital perspective, amphotericin B plus G-CSF is cost effective compared with amphotericin B monotherapy in managing a presumed deep-seated fungal infection in neutropenic patients. This result should provide strong arguments to clinicians and policy-makers for the adoption of this treatment strategy in such patients.

Keywords: Pharmacoeconomics; Mycoses, treatment; Cost-analysis; Resource-use; Amphotericin-B-lipid-complex-The-Liposome-Company,; Amphotericin-B-liposomal-NeXstar, therapeutic-use; Molgramostim, therapeutic-use; Lenograstim, therapeutic-use; Filgrastim, therapeutic-use; Antifungals, therapeutic-use; Colony-stimulating-factors, therapeutic-use

Language: English

Document Type: Original article

Affiliations: 1: Catalyst Health Economics Consultants Ltd, Pinner, Middlesex, UK 2: Department of Haematology, The Royal London Hospital, London, UK *

Publication date: 1999-11-01

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• In this Subject: Pharmacology
• By this author: Flynn T.N. ;  Kelsey S.M. ;  Hazel D.L. ;  Guest J.F.

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