Dr. Wilke GmbH, inspiring.health, München, Germany.
Eur J Med Res. 2011 Apr 28;16(4):180-6. doi: 10.1186/2047-783x-16-4-180.
Invasive fungal infections are on the rise. Echinocandins are a relatively new class of antifungal drugs that act by inhibition of a key enzyme necessary for integrity of the fungal cell wall. Currently there are three available agents: caspofungin, micafungin and anidulafungin. While the individual echinocandin antifungals have a different spectrum of licensed indications, basically all of them are available for the treatment of candidemia and invasive candidiasis. Antifungal treatment modalities basically include in therapy for suspected or proven infection and prophylaxis. All three drugs are comparatively expensive. Therefore a systematic review of the literature was performed to investigate the following aspects: * General aspects of cost-effectiveness in the treatment of invasive fungal infections * Cost-effectiveness of the treatment with the above-mentioned antifungals * Cost-effectiveness in two settings: therapy and prophylaxis - Early initiation of antifungal therapy, adjustment after availability of microbiological results, duration of therapy, success and occurrence of severe complications (e.g. renal failure) are the most important cost drivers in antifungal therapy. - Considering the specific antifungals, for caspofungin the best evidence for cost-effectiveness is found in treatment of invasive candidiasis and in empiric therapy of suspected infections. Favourable economic data are available for micafungin as a cost-effective alternative to LAmB for prophylaxis in patients with hematopoietic stem cell transplantation (HSCT). For anidulafungin, cost-effectiveness was demostrated in a pharmacoeconomic model. Net savings - yet not significant - were observed in a retrospective chart review of 234 patients. Generally, however, most analyses are still based on pharmacoeconomic modelling rather than direct analysis of trial data or real-life clinical populations. - As an overall conclusion, using caspofungin, micafungin, or anidulafungin is not more expensive than using other established therapies. Micafungin has proven to be cost-effective in prophylaxis if the local fungal epidemiology indicates a high level of resistance to fluconazole. Switch strategies involving early initiation of broadly active therapy with switch to cheaper alternatives according to microbiology results and clinical status and early initiation of an appropriate therapy have been proven to be cost-efficient independent of the antifungal agent.
侵袭性真菌感染的发病率正在上升。棘白菌素类是一类新型抗真菌药物，通过抑制真菌细胞壁完整性所必需的关键酶来发挥作用。目前有三种可用的药物：卡泊芬净、米卡芬净和阿尼芬净。虽然各个棘白菌素类抗真菌药物的适应证谱不同，但基本上都可用于治疗念珠菌血症和侵袭性念珠菌病。抗真菌治疗方法基本上包括疑似或确诊感染的治疗和预防。这三种药物都比较昂贵。因此，我们进行了系统的文献回顾，以调查以下方面：* 治疗侵袭性真菌感染的成本效益的一般方面* 上述抗真菌药物治疗的成本效益* 两种情况下的成本效益：治疗和预防 - 在抗真菌治疗中，最重要的成本驱动因素是：早期开始抗真菌治疗、根据微生物学结果调整治疗、治疗持续时间、疗效和严重并发症（如肾功能衰竭）的发生。- 考虑到特定的抗真菌药物，对于卡泊芬净，在治疗侵袭性念珠菌病和经验性治疗疑似感染方面，发现了最具成本效益的最佳证据。对于造血干细胞移植（HSCT）患者，米卡芬净作为两性霉素 B 的经济有效的替代物用于预防，具有有利的经济数据。对于阿尼芬净，在药物经济学模型中证明了其成本效益。在对 234 名患者的回顾性图表审查中观察到净节省-但无统计学意义。然而，总体而言，大多数分析仍然基于药物经济学建模，而不是直接分析试验数据或真实临床人群。- 作为一个总体结论，使用卡泊芬净、米卡芬净或阿尼芬净并不比使用其他已确立的疗法更昂贵。如果当地真菌流行病学表明对氟康唑的耐药率较高，则米卡芬净已被证明在预防方面具有成本效益。早期开始广泛有效的治疗，并根据微生物学结果和临床状况进行治疗转换，以及早期开始适当的治疗的转换策略，已被证明在成本效益方面是独立于抗真菌药物的。
