Turner S J, Senol E, Kara A, Al-Badriyeh D, Dinleyici E C, Kong D C M
Department of Pharmacy Practice and Administration, Ernest Mario School of Pharmacy, Rutgers University, Piscataway, NJ, USA.
Mycoses. 2014 Aug;57(8):489-96. doi: 10.1111/myc.12187. Epub 2014 Mar 18.
Invasive fungal infections from febrile neutropenia are associated with significant cost and mortality. The mainstay of treatment has been liposomal amphotericin B, however, echinocandins and azoles have shown promise as alternative treatments. Data on clinical efficacy exist, however, data incorporating pharmacoeconomic considerations are required in Turkey. The aim of this study was to investigate the cost effectiveness of caspofungin vs. voriconazole in empiric treatment of febrile neutropenia in Turkey. A decision analytic model was utilised, built upon two randomised-controlled trials and supplemented with expert panel input from clinicians in Turkey. A five-point composite outcome measure was utilised and sensitivity analyses were performed to demonstrate the robustness of the model. The base case scenario resulted in caspofungin being preferred by TL2,533, TL29,256 and TL2,536 per patient treated, successfully treated patient and patient survival, respectively (approx. USD1414, 16 328 and 1415); sensitivity analyses did not change the outcome. Monte Carlo simulation highlighted a 78.8% chance of favouring caspofungin. The result was moderately sensitive to treatment duration and acquisition cost of the antifungal agents compared. This is the first pharmacoeconomic study comparing caspofungin to voriconazole within Turkey, resulting in an advantage towards caspofungin. The study will aid in formulary decision-making based on the clinical and economic consequences of each agent in the Turkish health care setting.
发热性中性粒细胞减少症引发的侵袭性真菌感染会带来高昂的成本和死亡率。治疗的主要药物一直是脂质体两性霉素B，不过，棘白菌素类和唑类药物已显示出作为替代治疗药物的潜力。虽然已有临床疗效数据，但土耳其还需要纳入药物经济学考量的数据。本研究的目的是调查在土耳其经验性治疗发热性中性粒细胞减少症时，卡泊芬净与伏立康唑的成本效益。利用了一个决策分析模型，该模型基于两项随机对照试验构建，并补充了来自土耳其临床医生的专家小组意见。采用了一个五点综合结局指标，并进行了敏感性分析以证明模型的稳健性。基础病例分析结果显示，每例接受治疗的患者、成功治疗的患者和患者存活情况方面，卡泊芬净分别比伏立康唑便宜2533土耳其里拉、29256土耳其里拉和2536土耳其里拉（约合1414美元、16328美元和1415美元）；敏感性分析并未改变结果。蒙特卡洛模拟突出显示卡泊芬净有78.8%的可能性更具优势。结果对治疗持续时间和所比较的抗真菌药物的采购成本中度敏感。这是土耳其第一项比较卡泊芬净和伏立康唑的药物经济学研究，结果显示卡泊芬净具有优势。该研究将有助于在土耳其医疗环境中，根据每种药物的临床和经济后果进行处方决策。
