English, Article edition: Cost Effectiveness of Amphotericin B plus G-CSF Compared with Amphotericin B Monotherapy: Treatment of Presumed Deep-Seated Fungal Infection in Neutropenic Patients in the UK Terry N. Flynn; Stephen M. Kelsey; Dena L. Hazel; ...

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Bookmark: http://trove.nla.gov.au/version/118692
Physical Description
  • article
Language
  • English

Edition details

Title
  • Cost Effectiveness of Amphotericin B plus G-CSF Compared with Amphotericin B Monotherapy: Treatment of Presumed Deep-Seated Fungal Infection in Neutropenic Patients in the UK
Author
  • Terry N. Flynn
  • Stephen M. Kelsey
  • Dena L. Hazel
  • Julian F. Guest
Physical Description
  • article
Notes
  • Objective: To assess the economic impact of adding granulocyte colony-stimulating factor (G-CSF) to amphotericin B to treat a presumed deep-seated fungal infection in neutropenic patients. This study was conducted from the perspective of the National Health Service (NHS) hospital sector. Design: We used our previously reported trial as the clinical basis for the analysis (see Participants and interventions). These data were combined with resource utilisation data, enabling us to construct a decision tree model of the treatment paths attributable to managing patients in each arm of the trial. The model was used to calculate the cost effectiveness of using amphotericin B plus G-CSF compared to amphotericin B monotherapy in neutropenic patients with a presumed deep-seated fungal infection. Setting: An adult leukaemia/​bone marrow transplant (BMT) unit in a large UK teaching hospital. Participants: Patients with a neutrophil count of <0.5 times 109/​L and having a presumed deep-seated fungal infection after either chemotherapy or stem cell/​bone marrow transplantation for haematological malignancy. Interventions: 29 patients received intravenous amphotericin B (1 mg/​kg daily) plus subcutaneous G-CSF (3 to 5 microg/​kg daily) and 30 patients received intravenous amphotericin B (1 mg/​kg daily) monotherapy. The clinical trial showed that 62% of patients responded to antifungal treatment with amphotericin B plus G-CSF compared to 33% of patients who responded to amphotericin B monotherapy (p =​ 0.027). Nonresponders went on to receive a lipid formulation of amphotericin B. Main outcome measure and results: The mean cost per patient treated with amphotericin B plus G-CSF was Lstg 11 247 and the corresponding cost for amphotericin B monotherapy was Lstg 14 317 (1996/​1997 values) - a cost reduction of Lstg 3070 per patient. Sensitivity analyses demonstrated that the addition of G-CSF to conventional amphotericin B in the treatment of a presumed deep-seated fungal infection offers not only clinical benefits, but cost benefits which are robust to changes in clinical and economic parameters. Conclusion: From a UK hospital perspective, amphotericin B plus G-CSF is cost effective compared with amphotericin B monotherapy in managing a presumed deep-seated fungal infection in neutropenic patients. This result should provide strong arguments to clinicians and policy-makers for the adoption of this treatment strategy in such patients.
  • Pharmacoeconomics, Mycoses, Cost-analysis, Resource-use, Amphotericin-B-lipid-complex-The-Liposome-Company, Amphotericin-B-liposomal-NeXstar, Molgramostim, Lenograstim, Filgrastim, Antifungals, Colony-stimulating-factors
  • RePEc:wkh:phecon:v:16:y:1999:i:5:p:543-550
Language
  • English
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