Kuti Joseph L, Kotapati Srividya, Williams Peter, Capitano Blair, Nightingale Charles H, Nicolau David P
Center for Anti-Infective Research and Development, Hartford Hospital, Hartford, Connecticut 06102, USA.
Pharmacoeconomics. 2004;22(5):301-10. doi: 10.2165/00019053-200422050-00004.
Potential differences in toxicity, potency and acquisition price among the liposomal amphotericin B formulations makes it unclear which agent is less costly when total resource consumption and treatment-associated costs are considered.
A retrospective cost-minimisation analysis in 51 patients was performed to compare the cost of amphotericin B lipid complex (ABLC) and liposomal amphotericin B (L-AMB) from the hospital perspective. Costs ($US, 2001 values) were divided into level I (acquisition price only), level II (costs of all associated treatment, i.e. adverse events, failures, etc.) and level III (total fungal-related hospitalisation) costs.
No significant differences in patient demographics or length of therapy were apparent among those receiving ABLC or L-AMB. The clinical success rate in this population was similar between ABLC and L-AMB (53% vs 60%, p = 0.68), thus justifying the use of a cost-minimisation analysis. Among patients with baseline elevations in serum creatinine, 47% receiving ABLC and 10% receiving L-AMB experienced further increases in serum creatinine (p = 0.025). No differences in total treatment costs (level I, II, or III) were evident between patients receiving ABLC or L-AMB. When adjusted for duration of therapy, however, costs were significantly lower for ABLC than for L-AMB (level I: ABLC $US340 versus L-AMB $US435, p = 0.002; level II: ABLC $US361 versus L-AMB $US454, p = 0.027). The costs attributable to the prevention or treatment of adverse events were not different between the two treatments, and the economic outcome in this analysis was highly sensitive to the acquisition price and dosage of the lipid antifungal formulation. Two-way sensitivity analysis revealed that as long as the milligram price of L-AMB was greater than 135% of the milligram price of ABLC, ABLC remained the less costly formulation.
In this patient population, total hospitalisation costs were not different between lipid antifungal formulations. However, after controlling for duration of therapy, ABLC was less costly than L-AMB, when considering acquisition costs of the lipid antifungal agent and costs associated with concomitant antifungal therapy and the treatment of adverse events or lipid failures, indicating that the acquisition price of these agents should be predictive of their cost differences.
脂质体两性霉素B制剂在毒性、效力和购置价格方面存在潜在差异，这使得在考虑总资源消耗和治疗相关成本时，不清楚哪种制剂成本更低。
从医院角度对51例患者进行回顾性成本最小化分析，以比较两性霉素B脂质复合物（ABLC）和脂质体两性霉素B（L-AMB）的成本。成本（2001年美元价值）分为一级成本（仅购置价格）、二级成本（所有相关治疗的成本，即不良事件、治疗失败等）和三级成本（与真菌相关的住院总费用）。
接受ABLC或L-AMB治疗的患者在人口统计学特征或治疗时长方面无显著差异。ABLC和L-AMB在该人群中的临床成功率相似（53%对60%，p = 0.68），因此进行成本最小化分析是合理的。在血清肌酐基线升高的患者中，接受ABLC治疗的患者有47%血清肌酐进一步升高，接受L-AMB治疗的患者有10%血清肌酐进一步升高（p = 0.025）。接受ABLC或L-AMB治疗的患者在总治疗成本（一级、二级或三级）方面无明显差异。然而，在根据治疗时长进行调整后，ABLC的成本显著低于L-AMB（一级成本：ABLC为340美元，L-AMB为435美元，p = 0.002；二级成本：ABLC为361美元，L-AMB为454美元，p = 0.027）。两种治疗在预防或治疗不良事件方面的成本无差异，且该分析中的经济结果对脂质抗真菌制剂的购置价格和剂量高度敏感。双向敏感性分析显示，只要L-AMB的毫克价格大于ABLC毫克价格的135%，ABLC仍是成本较低的制剂。
在该患者群体中，脂质抗真菌制剂的住院总费用无差异。然而，在控制治疗时长后，考虑到脂质抗真菌药物的购置成本以及与抗真菌治疗及不良事件或脂质治疗失败相关的成本，ABLC的成本低于L-AMB，这表明这些药物的购置价格应能预测其成本差异。
