Abstract

MOULD-QUEVEDO, Joaquín F. et al. Empirical anti-mycotic treatment of immunocompromised patients with neutropenia and persistent fever with suspicion of systemic aspergillosis: Cost-effectiveness study in Mexico. Bol. Med. Hosp. Infant. Mex. [online]. 2009, vol.66, n.3, pp.241-253. ISSN 1665-1146.

Introduction. Systemic mycosis has a great impact on medical care costs. The objective of this study was to assess the most cost-effective empirical treatment for systemic aspergillosis, evaluating amphotericin B, caspofungin and voriconazole in patients with persistent fever and neutropenia. Methods. A decision-tree model was used to estimate expected clinical results and costs associated with the treatment for systemic aspergillosis. The study used a healthcare payer's perspective (Mexican Institute of Social Security, IMSS). Time frame was 12 weeks. Effectiveness measure was complete remission of mycotic infection. One-way and probabilistic sensitivity analyses were performed. Results. Average total expected costs per patient for the voriconazole treatment were US $57 378.58, for amphotericin B US $72 833.96, and for caspofungin were US $49 962.37. Thetotal expected remission rate without any adverse events was 37% for caspofungin, 43.6% for voriconazole and 51.1% for amphotericin B. Probabilistic sensitivity analysis showed that voriconazole would be a cost-effective treatment with 65% confidence, regardless of the willingness to pay the IMSS. Conclusions. The results of the study agree with the recommendation that voriconazole must be the empirical treatment for systemic aspergillosis, proposed as a standard first-line antifungal drug.

Keywords : Aspergillosis; invasive; fungal; systemic infection; antifungal agents; mycoses; cost-benefit analysis; cost effectiveness.

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