Romá-Sánchez E, Poveda-Andrés J L, García-Pellicer J, Salavert-Lletí M, Jarque-Ramos I
Servicio de Farmacia, Hospital Universitario La Fe, Valencia, Spain.
Farm Hosp. 2008 Jan-Feb;32(1):7-17.
Observational study performing a cost-effectiveness analysis of the empirical antifungal strategy in high-risk oncohaematological patients, from the hospital perspective and with an average time horizon of 10.8 days of treatment.
Data gathered: effectiveness, purchase costs and other costs (diagnostic tests, hospitalisation, and second-line antifungal therapy). A total of 107 patients were analysed, 115 invasive fungal infection sub-episodes and 138 empirical treatments.
The effectiveness and average cost/treatment were: voriconazole 88% and 20,108.8 euro, caspofungin 68% and 49,067.7 euro, Amphotericin B Lipid Complex (ABLC) 58% and 30,375.2 euro, and Amphotericin B Liposome (AB-L) 50% and 38,234.5 euro. The first tree designed shows voriconazole as the dominant option, although there are few case studies. The second tree selects ABLC in comparison to AB-L and caspofungin, with an average CE of 52,371 euro, the nearest figure to the established availability to pay (50,000 euro). The sensitivity analysis evaluates the most influential parameters. The variation in the cost of purchasing do not modify the sense of the analysis, and the modification of 25% in other costs for caspofungin reverses the ratio, making this the most cost-effective option. The ICE indicates that using voriconazole instead of caspofungin saves 144,794 euro. With regard to caspofungin, ABLC increases the cost by 186,925 euro, a deceptive figure influenced by a level of effectiveness that is not very different; and AB-L increases the cost by 60,184 euro.
The analysis provides relevant information from the perspective of clinical practice in spite of the limitations of the unconsidered costs (nephrotoxicity). This type of analysis contributes to rationalising the use of antifungal agents in the hospital setting and in high-risk patients such as oncohaematological ones.
从医院角度出发，对高危肿瘤血液科患者的经验性抗真菌策略进行成本效益分析的观察性研究，治疗平均时间范围为10.8天。
收集的数据包括：有效性、采购成本和其他成本（诊断检查、住院和二线抗真菌治疗）。共分析了107例患者、115次侵袭性真菌感染亚发作和138次经验性治疗。
有效性和平均每次治疗成本分别为：伏立康唑88%和20,108.8欧元，卡泊芬净68%和49,067.7欧元，两性霉素B脂质复合物（ABLC）58%和30,375.2欧元，以及两性霉素B脂质体（AB-L）50%和38,234.5欧元。第一棵设计的决策树显示伏立康唑为主要选择，尽管案例研究较少。第二棵决策树将ABLC与AB-L和卡泊芬净进行比较，平均成本效益为52,371欧元，最接近既定的支付能力（50,000欧元）。敏感性分析评估了最具影响力的参数。采购成本的变化不会改变分析结果，卡泊芬净其他成本变化25%会使比例逆转，使其成为最具成本效益的选择。增量成本效果比表明，使用伏立康唑而非卡泊芬净可节省144,794欧元。对于卡泊芬净而言，ABLC使成本增加186,925欧元，这一误导性数字受有效性水平差异不大的影响；AB-L使成本增加60,184欧元。
尽管存在未考虑成本（肾毒性）的局限性，但该分析从临床实践角度提供了相关信息。此类分析有助于使医院环境中以及肿瘤血液科等高危患者合理使用抗真菌药物。
