Stam Wiro B, Aversa Franco, Kumar Ritesh N, Jansen Jeroen P
Mapi Values, Houten, The Netherlands.
Value Health. 2008 Sep-Oct;11(5):830-41. doi: 10.1111/j.1524-4733.2008.00324.x. Epub 2008 May 20.
To evaluate the cost-effectiveness of caspofungin versus liposomal amphotericin B as empiric antifungal treatment in patients with neutropenic fever in Italy.
The cost-effectiveness of caspofungin versus liposomal amphotericin B was evaluated using a decision-tree model. Patients were stratified by presence or absence of baseline infection. Model outcomes included success in terms of resolution of fever, resolution of baseline infection, absence of breakthrough infection, survival, and quality-adjusted life years (QALYs) saved. Discontinuation because of nephrotoxicity or other adverse events were included in the model. Efficacy and safety data were based on a randomized, double-blind, multinational trial of caspofungin compared to liposomal amphotericin B (Walsh 2004). Information on life expectancy, quality of life, medical resource consumption, and costs was obtained from the literature.
The caspofungin estimated total treatment cost amounted to 8351 euros (95% uncertainty interval 7801 euros-8903 euros), which is 3470 euros (2575 euros-4382 euros) less than with liposomal amphotericin B. Treatment with caspofungin resulted in 0.25 (-0.11; 0.59) QALYs saved in comparison to treatment with liposomal amphotericin B. Probabilistic sensitivity analysis demonstrated a 93% probability that caspofungin was economically dominant, i.e., cost and QALY saving, and a probability of more than 99% that the costs per QALY saved were below 20,000 euros, a commonly accepted threshold for cost-effectiveness. Additional analyses with alternative doses of liposomal amphotericin B confirmed these findings.
Given the underlying assumptions, our economic evaluation demonstrated that caspofungin is cost-effective compared to liposomal amphotericin B in empiric antifungal treatment of patients with neutropenic fever in Italy.
评估在意大利，卡泊芬净与两性霉素B脂质体作为中性粒细胞减少伴发热患者经验性抗真菌治疗的成本效益。
采用决策树模型评估卡泊芬净与两性霉素B脂质体的成本效益。患者按有无基线感染进行分层。模型结果包括发热消退、基线感染消退、无突破性感染、生存以及节省的质量调整生命年（QALY）方面的成功情况。因肾毒性或其他不良事件停药也纳入模型。疗效和安全性数据基于卡泊芬净与两性霉素B脂质体的一项随机、双盲、多国试验（Walsh 2004）。从文献中获取有关预期寿命、生活质量、医疗资源消耗和成本的信息。
卡泊芬净估计的总治疗成本为8351欧元（95%不确定区间为7801欧元 - 8903欧元），比两性霉素B脂质体少3470欧元（2575欧元 - 4382欧元）。与两性霉素B脂质体治疗相比，卡泊芬净治疗节省了0.25（-0.11；0.59）个QALY。概率敏感性分析表明，卡泊芬净在经济上占主导地位的概率为93%，即成本更低且节省QALY，每节省一个QALY的成本低于20000欧元的概率超过99%，这是成本效益的一个普遍接受的阈值。对两性霉素B脂质体不同剂量的额外分析证实了这些结果。
基于基本假设，我们的经济评估表明，在意大利中性粒细胞减少伴发热患者的经验性抗真菌治疗中，卡泊芬净与两性霉素B脂质体相比具有成本效益。
