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Randomized Controlled Trial
. 2007 Jun;78(6):532-9.
doi: 10.1111/j.1600-0609.2007.00850.x. Epub 2007 Apr 5.

A cost-effectiveness analysis of caspofungin vs. liposomal amphotericin B for treatment of suspected fungal infections in the UK

Karin Bruynesteyn  1 , Vanya Gant, Catherine McKenzie, Tony Pagliuca, Chris Poynton, Ritesh N Kumar, Jeroen P Jansen
Affiliations
Randomized Controlled Trial

A cost-effectiveness analysis of caspofungin vs. liposomal amphotericin B for treatment of suspected fungal infections in the UK

Karin Bruynesteyn et al. Eur J Haematol. 2007 Jun.

Abstract

Objective: To evaluate the cost-effectiveness of caspofungin vs. liposomal amphotericin B in the treatment of suspected fungal infections in the UK.

Methods: The cost-effectiveness of caspofungin vs. liposomal amphotericin B was evaluated using a decision-tree model. The decision tree was populated using both data and clinical definitions from published clinical studies. Model outcomes included success in terms of resolution of fever, baseline infection, absence of breakthrough infection, survival and quality adjusted life years (QALYs) saved. Discontinuation due to nephrotoxicity or other adverse events were included in the model. Efficacy and safety data were based on additional analyses of a randomised, double blind, multinational trial of caspofungin compared with liposomal amphotericin B. Information on life expectancy, quality of life, medical resource consumption and costs were obtained from peer-reviewed published data.

Results: The caspofungin mean total treatment cost was 9762 pounds (95% uncertainty interval 6955-12,577), which was 2033 pounds (-2489; 6779) less than liposomal amphotericin B. Treatment with caspofungin resulted in 0.40 (-0.12; 0.94) additional QALYs saved in comparison with liposomal amphotericin B. Probabilistic sensitivity analysis found a 95% probability of the incremental cost per QALY saved being within the generally accepted threshold for cost-effectiveness (30,000 pounds). Additional analyses with varying dose of caspofungin and liposomal amphotericin B confirmed these findings.

Conclusion: Given the underlying assumptions, caspofungin is cost-effective compared with liposomal amphotericin B in the treatment of suspected fungal infections in the UK.

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Figures

Figure 1
Figure 1
Decision-tree model for cost-effectiveness evaluation of caspofungin vs. liposomal amphotericin B in the treatment of suspected.
Figure 2
Figure 2
Acceptability curve representing the probability that caspofungin is cost-effective in comparison to L-Amb for different values of willingness-to-pay for a quality adjusted life year saved.
See this image and copyright information in PMC

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