Cost-effective analysis of a biomarker-based versus the standard culture and histology-based diagnostic strategy for invasive aspergillosis (IA) in high-risk hematology patients

Nenad Macesic, Orla Morrissey, Danny Liew, Nicole Gilroy, Sharon C.A. Chen, Monica Slavin


Background: Empirical antifungal therapy is frequently used in haematology patients at high-risk of IA, with substantial cost and toxicity. Biomarkers for IA (Aspergillus galactomannan and PCR) enable earlier and more accurate diagnosis and targeted treatment of IA. However, data on the cost-effectiveness of a biomarker-based diagnostic strategy (BDS) are limited. Methods: A decision-analytic model was constructed to compare BDS with standard diagnostic strategy (SDS) of culture and histology in terms of total costs, IA incidence and years of life saved. Data inputs were derived from a published randomised controlled trial. Costs were estimated for each patient using hospital costing data and follow-up for survival was extended out to 360 days and 5 years. Results: Treatment costs were estimated for 158 adult patients receiving chemotherapy for acute leukaemia or undergoing allogeneic haemopoietic stem cell transplant in 4 Australian centers (30 September 2005 to 19 November 2009). Patients were followed for a median of 218.5 days (range 0 – 2681). Median cost of investigations using BDS was €791 per patient (IQR €615 – 879). Median total costs at 180 days were €58,863 (IQR €38,767 – 93,952) for SDS and €62,379 (IQR €44,601 - 191,292) for BDS, respectively. 0.012 (4.4 days), 0.025 (9.1 days) and 0.239 (2.9 months) years of life were saved per person for the BDS compared to SDS at 180 days, 1 year and 5 years, respectively. The costs per life year saved was €285, 209, €93,084 and €12,726 at 180 days, 1 year and 5 years, respectively. Conclusion: Compared to SDS, BDS is associated with slightly higher net costs, but greater survival, which is estimated to be sustained out to 5 years. BDS is not cost-effective in the short-term but appears to be a cost-effective strategy long-term.


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19th Congress of the International Society for Human and Animal Mycology
    • ISHAM 19th (2015)