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Supportive Care in Cancer
Published in: Supportive Care in Cancer 10/2011

01-10-2011 | Original Article

Medical cost analysis for antifungal prophylaxis in neutropenic patients with hematological malignancies: a systematic simulation analysis

Authors: Osamu Imataki, Yoshitsugu Kubota, Hiroaki Ohnishi, Akira Kitanaka, Toshihiko Ishida, Terukazu Tanaka

Published in: Supportive Care in Cancer | Issue 10/2011

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Abstract

Goals of work

We assessed the medical costs of different antifungal agents for prophylaxis of invasive fungal infections in neutropenic patients in Japan with a cost simulation model designed for the study.

Patients and methods

We used probabilities of prophylaxis failure, possible cases for empiric therapy, probable proportions of infections caused by fungus species among prophylaxis failure patients, and incidence of adverse events caused by any reason, based on systematic analysis of previously reported randomized trials identified by a computerized search of the PubMed database. Antifungal agents were limited to oral fluconazole, oral itraconazole, micafungin, and liposomal amphotericin B. The range of the expected medical cost was simulated as a sensitivity analysis using 95% of confidence interval of a mean.

Main results

Fifteen studies were identified for our analysis. The prophylactic efficacy was comparable between the four agents. The simulated expected cost for invasive fungal infection prophylaxis and treatment of the infection was $1,035.74 when oral itraconazole was used for prophylaxis, $1,552.81 with oral fluconazole, $2,245.96 with micafungin, and $3,028.10 with liposomal amphotericin B. The total cost including treatment cost for adverse events related to each drug was $2,742.14, $3,547.91, $3,034.57, and $3,028.10, respectively. This result was confirmed in a sensitivity analysis in which IFI incidence and therapy duration were tested as parameters.

Conclusions

Our analysis results suggest that oral itraconazole is the most cost-effective prophylactic antifungal agent for invasive fungal infections in neutropenic patients with hematological malignancies, and this result was robust by sensitivity analysis.
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Metadata
Title
Medical cost analysis for antifungal prophylaxis in neutropenic patients with hematological malignancies: a systematic simulation analysis
Authors
Osamu Imataki
Yoshitsugu Kubota
Hiroaki Ohnishi
Akira Kitanaka
Toshihiko Ishida
Terukazu Tanaka
Publication date
01-10-2011
Publisher
Springer-Verlag
Published in
Supportive Care in Cancer / Issue 10/2011
Print ISSN: 0941-4355
Electronic ISSN: 1433-7339
DOI
https://doi.org/10.1007/s00520-010-0998-3

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