Background: In July 2002, The Cleveland Clinic Foundation (CCF) adopted amphotericin B lipid complex (ABLC) as the preferred lipid amphotericin B product over liposomal amphotericin B (L-AMB) due to the considerable difference in contract pricing. L-AMB on contract (L-AMBon) is twice the cost of ABLC on contract. After this change, 12.5% of patients initiated on ABLC were switched to L-AMB due to intolerable infusion-related reactions (IRR). The off contract price of L-AMB (L-AMBoff) is five times the cost of ABLC. As a result, a cost analysis was performed to determine the least expensive formulary option, L-AMBon as the sole formulary agent (Scenario 1) or ABLC as the preferred agent with limited use of L-AMBoff for patients intolerant to ABLC (Scenario 2). Methods: A decision tree was constructed to compare costs per 10-day course of therapy with Scenario 1 or Scenario 2. Efficacy, which was assumed to be equal, was positioned at the first chance node. IRR rates for ABLC and L-AMB were obtained from drug use evaluations (DUE) performed at CCF (41% and 20%, respectively). Scenario 2 included an extra chance node to account for the different IRR treatment options, meperidine plus diphenhydramine or L-AMBoff (12.5%, as described above). One-way and two-way sensitivity analyses were performed to determine robustness of results. Results: The decision analysis determined that use of Scenario 2 would be approximately 20% less expensive than Scenario 1 per treatment course. All variables were tested with individual one-way sensitivity analyses, none of which impacted the overall result of the model. In order for costs per course of therapy to be equal between the two scenarios, 30% of patients would need to be switched from ABLC to L-AMBoff. Conclusions: ABLC is the least expensive option at our institution based on contract pricing, and incidence and treatment of IRR. ABLC is presently the preferred lipid amphotericin B product.
Full conference title:
43rd Interscience Conference on Antimicrobial Agents
- ICAAC 43rd