NDLI: Cost-effectiveness analysis of micafungin versus fluconazole for prophylaxis of invasive fungal infections in patients undergoing hematopoietic stem cell transplantation in Korea.

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Cost-effectiveness analysis of micafungin versus fluconazole for prophylaxis of invasive fungal infections in patients undergoing hematopoietic stem cell transplantation in Korea.

Content Provider	World Health Organization (WHO)-Global Index Medicus
Author	Sohn, Hyun Soon Lee, Tae-Jin Kim, Jinhyun Kim, Donghwan
Spatial Coverage	Korea
Description	Country affiliation: United States Author Affiliation: Sohn HS ( School of Pharmacy, Rutgers University, Piscataway, New Jersey, USA.)
Abstract	BACKGROUND: Invasive fungal infections are often fatal complications in patients undergoing hematopoietic stem cell transplantation (HSCT), and prophylactic antifungal treatment has been recommended. Within budget-limited health care environments, choosing a cost-effective drug is very important. OBJECTIVE: This study was conducted to analyze the cost-effectiveness of micafungin and fluconazole for prophylaxis of invasive fungal infections from the payer's perspective in patients undergoing HSCT in a Korean health care setting. METHODS: We constructed a decision-analytic model to evaluate both total costs for each state of health and outcomes (such as the fungal-infection prevention rate and life expectancy) for 2 alternatives in a hypothetical cohort of 100 patients undergoing HSCT. The target population was aged 43 years, weighed >50 kg, and had normal renal function. For prophylaxis against systemic fungal infections, patients were administered either micafungin 50 mg/d or fluconazole 400 mg/d, without dose adjustment, as a 1-hour infusion for a mean of 19 consecutive days. Depending on the clinical outcomes with prophylactic therapy, different treatments were assumed. Patients with proven/ probable fungal infection received acute antifungal therapy, and those with suspected fungal infection received empiric antifungal therapy. All patients received general medical care during the analysis period. Results are expressed as Korean won (KW; US \$1 = KW 925 as of December 1, 2007). RESULTS: The base-case analysis found that micafungin treatment, compared with fluconazole, saved KW 95,511,000, increased the number of infection-free patients by 0.5, and saved 4.8 life-years per 100 patients. Results with micafungin as the dominant strategy were found to be robust in sensitivity analyses for several parameters, including treatment success and failure rates; mortality risk ratio; and costs for general care, empiric therapy, and acute antifungal therapy. CONCLUSION: Micafungin was a cost-effective prophylactic antifungal strategy by providing lower medical costs and longer life expectancy than fluconazole from the payer's perspective in a hypothetical cohort of Korean adults undergoing HSCT.
File Format	HTM / HTML
ISSN	01492918
Issue Number	5
Volume Number	31
e-ISSN	1879114X
Journal	Clinical Therapeutics
Language	English
Publisher	Elsevier
Publisher Date	2009-05-01
Publisher Place	United States
Access Restriction	One Nation One Subscription (ONOS)
Subject Keyword	Discipline Pharmacology Antifungal Agents Economics Echinocandins Fluconazole Hematopoietic Stem Cell Transplantation Methods Lipopeptides Mycoses Prevention & Control Adult Therapeutic Use Chemoprevention Cohort Studies Cost-benefit Analysis Statistics & Numerical Data Decision Trees Humans Korea Odds Ratio Treatment Outcome Comparative Study Journal Article Research Support, Non-u.s. Gov't
Content Type	Text
Resource Type	Article
Subject	Pharmacology Pharmacology (medical)

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