Cost-Effectiveness of Caspofungin Vs. Liposomal Amphotericin B for Empiric Therapy in Turkey

Ref ID: 18784

Author:

S. J. Turner, Masters (MA or MS) – Research Fellow 1, E. Senol, MD – Professor 2, A. Kara, MD – Professor 3, D. Al-Badriyeh, PhD – Assistant Professor 4, D. C. M. Kong, PhD – Lecturer5, E. C. Dinleyici, MD – Associate Professor 6;

Author address:

1Univ. at Buffalo, Buffalo, NY, 2Gazi Univ., Ankara, Turkey, 3Hacettepe Univ., Ankara, Turkey, 4Qatar Univ., Doha, Qatar, 5Monash Univ., Melbourne, Australia, 6Eskisehir Osmangazi Univ., Eskisehir, Turkey.

Full conference title:

52nd Annual ICAAC

Date: 9 September 2014

Abstract:

Background: A major clinical trial demonstrated non-inferiority of caspofungin (CAS) vs. liposomal amphotericin B (LAMB) for empiric therapy of febrile neutropaenia (FN). This study investigated the cost-effectiveness of these options from the Turkish healthcare system’s perspective. Methods: A decision-tree analysis was used to capture downstream consequences of each agent. Outcome measures included success, breakthrough fungal infection, persistent base-line fungal infection, persistent fever, premature discontinuation and death. Patient probability data were extracted from a published clinical trial. Resource consumption and alternative treatment after initial failure with either agent were estimated by an expert panel. Cost was based on most recent available data within Turkey. Deterministic and probabilistic sensitivity analyses were performed to determine the model’s robustness, and enhance its generalizability. Results: Compared to LAMB per patient, CAS was dominant by TL$4,572, TL$14,729 and TL$4,584 for treatment, success and survival, respectively (approx. USD$2,560, $8,247 and $2,566, respectively). CAS had a higher likelihood of success and lower mortality than LAMB (34.17% vs. 33.58% and 7.37% vs. 10.76%, respectively). Increasing the list cost or length of stay (LOS) for CAS by > 63.3% or 2.3 days, respectively, resulted in CAS no longer being favorable. A decrease of list cost or LOS for LAMB by > 30.3% or 1.87 days resulted in it being favorable. Monte Carlo simulation (MCS) of 10,000 subjects, with variability imputed on the outcome probabilities taken from the literature, LOS and hospitalisation costs, resulted in a 76.7% chance of favoring CAS. Conclusions: This is the first economic evaluation in the Turkish setting for the empiric use of antifungal agents in FN, where CAS appears dominant over LAMB. Sensitivity analyses, including MCS, supported a robust advantage in favor of CAS, although outcome was highly sensitive to LOS.

Abstract Number: M-1671

Conference Year: 2012

Link to conference website: NULL

New link: NULL

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