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Pharmacoeconomics


Pharmacoeconomics of echinocandins


Despite the limitations of pharmacoeconomic studies, use of echinocandins in the treatment of invasive fungal disease, especially in invasive candidiasis, is associated with cost savings and is cost effective


Lubos Drgona MD PhD National Cancer Institute, Bratislava, Slovakia


Invasive fungal diseases (IFD) are relatively common complications in the high-risk population of


immunocompromised patients, for example, in patients with leukaemia, patients undergoing allogeneic haemopoietic stem cell transplantation (HSCT) or patients with complications at intensive care units (ICUs). These infections are difficult to treat and often costly.


The conomic impact of IFD can be assessed from the hospital, payer or societal perspective. Although the hospital perspective includes only costs that are incurred by the hospital (for example, costs of diagnostic tests, medications, hospitalisation), the payer perspective includes all direct medical costs (for example, primary treatment costs, costs of healthcare resource utilisation (HCRU) post-discharge) and societal perspective includes all direct medical and non- medical costs (for example, lost productivity), as well as indirect costs (for example, future lost productivity). Hospital perspective costs varied depending on the resources included in the analysis. Costs generally ranged from €8351–€11,821 when evaluating incremental hospitalisation and antifungal drug expenditure only, €3930–€7314 for antifungal drugs, €8252–€51,760 for hospital bed day costs and €26,596– €83,300 when all direct costs for management were included.1


The average added cost for patients with IFD is almost eight times greater.2 Antifungal therapy is the pillar of the management of IFD and the use of modern diagnostic methods together with early administration of antifungal drugs can improve the outcome of affected patients. The cost burden of IFD is high and is also associated with the use of newer, effective and less toxic antifungals, such as echinocandins. Caspofungin, micafungin and anidulafungin – all members of this group of antifungals – can be used as therapeutic agents for empirical, pre-emptive or directed treatment. The position of particular echinocandins varies according to their indication and recommendations. All of


them are indicated for the therapy of invasive candidaemia/candidiasis (IC), some of them are recommended for the treatment of invasive aspergillosis (IA) and for the empirical antifungal treatment in febrile neutropenic patients or for prophylaxis of IFD.


Echinocandins in the treatment of invasive candidaemia/candidiasis IC are infections with increasing incidence in developed countries, with high crude mortality (around 30–50%), and prolonged length of hospital stays. This has resulted in additional costs of US$21,000–68,000 per patient with IC.3 All echinocandins are indicated for the treatment of IC together with antifungals


www.hospitalpharmacyeurope.com


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