Economic analysis of empiric versus diagnostic-driven strategies for immunocompromised patients with suspected fungal infections in the People's Republic of China

Abstract

Invasive fungal infections (IFIs) require rapid diagnosis and treatment. A decision-analytic model was used to estimate total costs and survival associated with a diagnostic-driven (DD) or an empiric treatment approach in neutropenic patients with hematological malignancies receiving chemotherapy or autologous/allogeneic stem cell transplants in Shanghai, Beijing, Chengdu, and Guangzhou, the People's Republic of China. Treatment initiation for the empiric approach occurred after clinical suspicion of an IFI; treatment initiation for the DD approach occurred after clinical suspicion and a positive IFI diagnostic test result. Model inputs were obtained from the literature; treatment patterns and resource use were based on clinical opinion. Total costs were lower for the DD versus the empiric approach in Shanghai (¥3,232 vs ¥4,331), Beijing (¥3,894 vs ¥4,864), Chengdu, (¥4,632 vs ¥5,795), and Guangzhou (¥8,489 vs ¥9,795). Antifungal administration was lower using the DD (5.7%) than empiric (9.8%) approach, with similar survival rates. Results from one-way and probabilistic sensitivity analyses were most sensitive to changes in diagnostic test sensitivity and IFI incidence; the DD approach dominated the empiric approach in 88% of scenarios. These results suggest that a DD compared to an empiric treatment approach in the People's Republic of China may be cost saving, with similar overall survival in immunocompromised patients with suspected IFIs.

Keywords: aspergillosis; caspofungin; cost-effectiveness analysis; itraconazole; voriconazole.

Figure 1

Model structure. (A) Diagnostic-driven treatment approach. (B) Empiric treatment approach. Note: [+], repetition of sub-tree (as shown for itraconazole therapy above). Abbreviation: IFI, invasive fungal infection.

Figure 2

One-way sensitivity analyses on incremental cost per death avoided comparing DD and empiric treatment approaches in Shanghai, the People’s Republic of China. Abbreviations: CT, computed tomography; DD, diagnostic driven; base, base case; emp, empiric; GM, galactomanan test; IFI, invasive fungal infection; LB, lower bound; QD, daily; UB, upper bound.

Figure 3

Probabilistic sensitivity analysis scatter plot showing the incremental costs (in Chinese ¥) per death avoided for a DD compared to an empiric treatment approach in Shanghai, the People’s Republic of China. Abbreviation: DD, diagnostic-driven.