Skip to main content

Advertisement

Log in

An update on the pharmacoeconomics of antifungal pharmacotherapy

  • Published:
Current Fungal Infection Reports Aims and scope Submit manuscript

Abstract

The incidence and severity of invasive fungal infections are on the rise and they pose a risk of significant morbidity and mortality. The cost burden of fungal infections in the United States is high. There are many newer, less toxic antifungal agents to manage these challenging infections; however, these agents also carry a high cost of their own. When considering an antifungal agent for a specific patient, it is important to consider safety, efficacy, and cost, thus making it essential to continually evaluate the antifungal pharmacoeconomic literature to assist in the therapeutic decision-making process for patients with invasive fungal infections. Unfortunately, there is a lack of pharmacoeconomic studies addressing the costs associated with the treatment and prevention of fungal infections. Future large-scale clinical studies should include pharmacoeconomic analyses and end points that encompass all costs associated with antifungal drug use, not solely drug acquisition costs.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References and Recommended Reading

  1. Levit K, Cowan C, Lazenby H, et al.: Health spending in 1998. Health Aff 2000, 19:124–132.

    Article  CAS  Google Scholar 

  2. Wilson LS, Reyes CM, Stolpman M, et al.: The direct cost and incidence of systemic fungal infections. Value Health 2002, 5:26–34.

    Article  PubMed  Google Scholar 

  3. Arenas-Guzman R, Tosti A, Hay R, et al.: Pharmacoeconomics-an aid to better decision-making. J Eur Acad Dermatol Venereol 2005, 19:34–39.

    Article  PubMed  Google Scholar 

  4. Johnson MD, Kleinberg M, Danziger L, et al.: Pharmacoeconomics of antifungal pharmacotherapy — challenges and future directions. Expert Opin Pharmacother 2005, 6:2617–2632.

    Article  PubMed  CAS  Google Scholar 

  5. Cornerly OA, Maertens J, Winston DJ, et al.: Posaconazole vs. fluconazole or itraconazole prophylaxis in patients with neutropenia. N Engl J Med 2007, 356:348–349.

    Article  Google Scholar 

  6. U.S. Department of Labor. Bureau of Labor Statistics. Consumer Price Indexes.

  7. Collins CD, Ellis JJ, Kaul DR: Comparative cost-effectiveness of posaconazole versus fluconazole or itraconazole prophylaxis in patients with prolonged neutropenia. Am J Health-Syst Pharm 2008, 65:2237–2243.

    Article  PubMed  CAS  Google Scholar 

  8. Kanda Y, Yamamoto R, Chizuka K, et al.: Prophylactic action of oral fluconazole against fungal infection of neutropenic patients: a meta-analysis of 16 randomized, controlled trials. Cancer 2000, 89:1611–1625.

    Article  PubMed  CAS  Google Scholar 

  9. Glasmacher A, Prentice A, Gorschluter M, et al.: Itraconazole prevents invasive fungal infections in neutropenic patients treated for hematologic malignancies: evidence from a meta-analysis of 3,597 patients. J Clin Oncol 2003, 21:4615–4626.

    Article  PubMed  CAS  Google Scholar 

  10. Menzin J, Lang KM, Friedman M, et al.: Excess mortality, length of stay, and costs associated with serious fungal infections among elderly cancer patients: findings from linked SEER-Medicare data. Value Health 2005, 8:140–148.

    Article  PubMed  Google Scholar 

  11. de Vries R, Daenen S, Tolley K, et al.: Cost effectiveness of itraconazole in the prophylaxis of invasive fungal infections. Pharmacoeconomics 2008, 26:75–90.

    Article  PubMed  Google Scholar 

  12. Riedel A, Choe L, Inciardi J, et al.: Antifungal prophylaxis in chemotherapy-associated neutropenia: a retrospective, observational study. BMC Infect Dis 2007, 7:70.

    Article  PubMed  Google Scholar 

  13. Schonfeld W, Cheng W, Tong KB, et al.: Cost-effectiveness analysis of antifungal prophylaxis in patients undergoing hematopoietic stem cell transplantation. Clin Ther 2008, 30:964–973.

    Article  PubMed  CAS  Google Scholar 

  14. van Burik JA, Ratanatharathorn V, Stepan DE, et al.: Micafungin versus fluconazole for prophylaxis against invasive fungal infections during neutropenia in patients undergoing hematopoietic stem cell transplantation. Clin Infect Dis 2004, 39:1407–1416.

    Article  PubMed  Google Scholar 

  15. Red Book. Montvale, NJ: Medical Economics Co, Inc; 2006.

  16. Cagnoni PJ, Walsh TJ, Prendergast MM, et al.: Pharmacoeconomic analysis of liposomal amphotericin B versus conventional amphotericin B in the empirical treatment of persistently febrile neutropenic patients. J Clin Oncol 2000, 18:2476–2483.

    PubMed  CAS  Google Scholar 

  17. Walsh TJ, Finberg RW, Arndt C, et al.: Liposomal amphotericin B for empirical therapy in patients with persistent fever and neutropenia. N Engl J Med 1999, 340:764–771.

    Article  PubMed  CAS  Google Scholar 

  18. Bates DW, Su L, Yu DT, et al.: Mortality and costs of acute renal failure associated with amphotericin B therapy. Clin Infect Dis 2001, 32:686–693.

    Article  PubMed  CAS  Google Scholar 

  19. Harbarth S, Burke JP, Lloyd JF, et al.: Clinical and economic outcomes of conventional amphotericin B-associated nephrotoxicity. Clin Infect Dis 2002, 35:120–127.

    Article  Google Scholar 

  20. Wingard JR, Wood CA, Sullivan E, et al.: Caspofungin versus amphotericin B for candidemia: a pharmacoeconomic analysis. Clin Ther 2005, 27:960–969.

    Article  PubMed  CAS  Google Scholar 

  21. Collins CD, Stuntebeck ER, DePestel DD, et al.: Pharmacoeconomic analysis of liposomal amphotericin B versus voriconazole for empirical treatment of febrile neutropenia. Clin Drug Investig 2007, 27:233–241.

    Article  PubMed  CAS  Google Scholar 

  22. Shehab N, DePestel DD, Mackler ER, et al.: Institutional experience with voriconazole compared with liposomal amphotericin B as empiric therapy for febrile neutropenia. Pharmacotherapy 2007, 27:970–979.

    Article  PubMed  CAS  Google Scholar 

  23. Wingard JR, Leather HL, Wood CA, et al.: Pharmacoeconomic analysis of caspofungin versus liposomal amphotericin B as empirical antifungal therapy for neutropenic fever. Am J Health-Syst Pharm 2007, 64:637–643.

    Article  PubMed  CAS  Google Scholar 

  24. Edmond MB, Wallace SE, McClish DK, et al.: Nosocomial bloodstream infections in United States hospitals: a three-year analysis. Clin Infect Dis 1999, 29:239–244.

    Article  PubMed  CAS  Google Scholar 

  25. Zaoutis TE, Argon J, Chu J, et al.: The epidemiology and attributable outcomes of candidemia in adults and children hospitalized in the United States: a propensity analysis. Clin Infect Dis 2005, 41:1232–1239.

    Article  PubMed  Google Scholar 

  26. Morgan J, Meltzer MI, Plikaytis BD, et al.: Excess mortality, hospital stay, and cost due to candidemia: a case-control study using data from population-based candidemia surveillance. Infect Cont Hosp Epidemiol 2005, 26:540–547.

    Article  Google Scholar 

  27. Gudlaugsson O, Gillespie S, Lee K, et al.: Attributable mortality of nosocomial candidemia, revisited. Clin Infect Dis 2003, 37:1172–1176.

    Article  PubMed  Google Scholar 

  28. Rentz AM, Halpern MT, Bowden R: The impact of candidemia on length of hospital stay, outcome, and overall cost of illness. Clin Infect Dis 1998, 27:781–788.

    Article  PubMed  CAS  Google Scholar 

  29. Mora-Duarte J, Betts R, Rotstein C, et al.: Comparison of caspofungin and amphotericin B for invasive candidiasis. N Engl J Med 2002, 347:2020–2029.

    Article  PubMed  CAS  Google Scholar 

  30. Garey K, Turpin RS, Bearden DT, et al.: Economic analysis of inadequate fluconazole therapy in non-neutropenic patients with candidemia: a multi-institutional study. Int J Antimicrob Agents 2007, 29:557–562.

    Article  PubMed  CAS  Google Scholar 

  31. Cornely OA, Sidhu M, Odeyemi I, et al.: Economic analysis of micafungin versus liposomal amphotericin B for treatment of candidaemia and invasive candidiasis in Germany. Curr Med Res Opin 2008, 24:1743–1753.

    Article  PubMed  CAS  Google Scholar 

  32. Dasbach EJ, Davies GM, Teutsch SM: Burden of aspergillosis-related hospitalizations in the United States. Clin Infect Dis 2000, 31:1524–1528.

    Article  PubMed  CAS  Google Scholar 

  33. Lin SJ, Schranz J, Teutsch SM: Aspergillosis case-fatality rate: systematic review of the literature. Clin Infect Dis 2001, 32:358–366.

    Article  PubMed  CAS  Google Scholar 

  34. Briegel J, Forst H, Spill B, et al.: Risk factors for systemic fungal infections in liver transplant recipients. J Clin Microbiol Infect Dis 1995, 14:375–382.

    Article  CAS  Google Scholar 

  35. Wenzel R, Del Favero A, Kibbler C, et al.: Economic evaluation of voriconazole compared with conventional amphotericin B for the primary treatment of aspergillosis in immunocompromised patients. J Antimicrob Chemother 2005, 55:352–361.

    Article  PubMed  CAS  Google Scholar 

  36. Garbino J, Schnetzler G, Roberts C: Invasive aspergillosis: Is treatment with “inexpensive” amphotericin B cost-saving if “expensive” voriconazole is only used on demand? Swiss Med Wkly 2005, 135:624–630.

    Google Scholar 

  37. Lewis JS, Boucher HW, Lubowski TJ, et al.: Cost advantage of voriconazole over amphotericin b deoxycholate for primary treatment of invasive aspergillosis. Pharmacotherapy 2005, 25:839–846.

    Article  PubMed  CAS  Google Scholar 

  38. Jansen JP, Kern WV, Cornely OA, et al.: Economic evaluation of voriconazole versus conventional amphotericin b in the treatment of invasive aspergillosis in Germany. Value Health 2006, 9:12–23.

    Article  PubMed  Google Scholar 

  39. Dominguez-Gil A, Martin I, Garcia Vargas M, et al.: Economic evaluation of voriconazole versus caspofungin for the treatment of invasive aspergillosis in Spain. Clin Drug Invest 2007, 27:197–205.

    Article  CAS  Google Scholar 

  40. Wingard JR, Herbrecht R, Mauskopf J, et al.: Resource use and cost of treatment with voriconazole or conventional amphotericin B for invasive aspergillosis. Transpl Infect Dis 2007, 9:182–188.

    Article  PubMed  CAS  Google Scholar 

  41. Greene RE, Mauskopf J, Roberts CS, et al.: Comparative cost-effectiveness of voriconazole and amphotericin B in the treatment of invasive pulmonary aspergillosis. Am J Health-Syst Pharm 2007, 64:2561–2568.

    Article  PubMed  CAS  Google Scholar 

  42. Van Campenhout H, Marbaix S, Derde MP, et al.: Voriconazole treatment of invasive Aspergillosis. Clin Drug Invest 2008, 28:509–521.

    Article  Google Scholar 

  43. Herbrecht R, Denning DW, Patterson TF, et al.: Voriconazole versus amphotericin B for primary therapy of invasive aspergillosis. N Engl J Med 2002, 347:408–415.

    Article  PubMed  CAS  Google Scholar 

  44. Collett G, Parrish A: Fluconazole donation and outcomes assessment in cryptococcal meningitis. S Afr Med J 2007, 97:175–176.

    PubMed  CAS  Google Scholar 

  45. Hamill RJ: Free fluconazole for cryptococcal meningitis: too little of a good thing? Clin Infect Dis 2006, 43:1074–1076.

    Article  PubMed  Google Scholar 

  46. Marr KA, Boeckh M, Carter RA, et al.: Combination antifungal therapy for invasive aspergillosis. Clin Infect Dis 2004, 39:797–802.

    Article  PubMed  CAS  Google Scholar 

  47. Kontoyiannis DP, Ratanatharathorn V, Young JA, et al.: Micafungin alone or in combination with other systemic antifungal therapies in hematopoietic stem cell transplant recipients with invasive aspgergillosis. Transpl Infect Dis 2009, 11:89–93.

    Article  PubMed  CAS  Google Scholar 

  48. Antoniadou A, Kontoyiannis DP: Status of combination therapy for refractory mycoses. Curr Opin Infect Dis 2003, 16:539–545.

    Article  PubMed  CAS  Google Scholar 

  49. Baddley JW, Pappas PG: Antifungal combination therapy. Drugs 2005, 65:1461–1480.

    Article  PubMed  CAS  Google Scholar 

  50. Cuenca-Estrella M: Combinations of antifungal agents in therapy—what value are they? J Antimicrob Chemother 2004, 54:854–869.

    Article  PubMed  CAS  Google Scholar 

  51. Johnson MD, Perfect JR: Combination antifungal therapy: what can and should we expect? Bone Marrow Transplant 2007, 40:297–306.

    Article  PubMed  CAS  Google Scholar 

  52. Singh N, Limaye AP, Forrest G, et al.: Combination of voriconazole and caspofungin as primary therapy for invasive aspergillosis in solid organ transplant recipients: a prospective, multicenter, observational study. Transplantation 2006, 81:320–326.

    Article  PubMed  CAS  Google Scholar 

  53. Baddley JW, Pappas PG: Combination antifungal therapy for the treatment of invasive yeast and mold infections. Curr Infect Dis Rep 2007, 9:448–456.

    Article  PubMed  Google Scholar 

  54. Stanzani M, Vianelli N, Bandini G, et al.: Successful treatment of disseminated Fusariosis after allogenic hematopoietic stem cell transplantation with the combination of voriconazole and liposomal amphotericin B. J Infect 2006, 53:243–246.

    Article  Google Scholar 

  55. Sanchez LA: Applied pharmacoeconomics: evaluation and use of pharmacoeconomic data from the literature. Am J Health-Syst Pharm 1999, 56:1630–1638.

    PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Sarah M. Wieczorkiewicz.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Wieczorkiewicz, S.M., Jourjy, J. & Danziger, L. An update on the pharmacoeconomics of antifungal pharmacotherapy. Curr Fungal Infect Rep 3, 103–110 (2009). https://doi.org/10.1007/s12281-009-0014-x

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12281-009-0014-x

Keywords

Navigation