Skip to main content
SpringerLink
Log in

Costs of Antifungal Prophylaxis After Bone Marrow Transplantation

A Model Comparing Oral Fluconazole, Liposomal Amphotericin and Oral Polyenes as Prophylaxis Against Oropharyngeal Infections

  • Original Research Articles
  • Published:
PharmacoEconomics Aims and scope Submit manuscript

Abstract

The costs per successfully treated patient over a 12-week period were £28 956 (£1 = $US 1.60, June 1995) for oral fluconazole, £53 225 for liposomal amphotericin and £32 768 for oral polyenes. Sensitivity analysis showed that the costs of liposomal amphotericin always exceeded those of the oral comparators, reflecting its high acquisition, preparation and administration costs.

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

Access this article

Log in via an institution

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

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Welch HG, Larson EB. Cost effectiveness of bone marrow transplantation in acute nonlymphocytic leukemia. N Engl J Med 1989; 321 (12): 807–12

    Article  PubMed  CAS  Google Scholar 

  2. Wujcik D, Downs S. Bone marrow transplantation. Tissue Organ Transplant 1992; 4 (1): 149–66

    CAS  Google Scholar 

  3. Sullivan KM. Current status of bone marrow transplantation. Transplant Proc 1989; 21 (3): 41–50

    PubMed  CAS  Google Scholar 

  4. Pirsch JD, Maki DG. Infectious complications in adults with bone marrow transplantation and T-cell depletion of donor marrow. Ann Intern Med 1986; 104: 619–31

    PubMed  CAS  Google Scholar 

  5. Dreizen S, McCredie KB, Keating MJ. et al. Oral infection associated with chemotherapy in adults with acute leukaemia. Postgrad Med 1982; 71 (6): 133–46

    PubMed  CAS  Google Scholar 

  6. Goodman JL, Winston DJ, Greenfield RA, et al. A controlled trial of fluconazole to prevent fungal infections in patients undergoing bone marrow transplantation. N Engl J Med 1992; 326 (13): 845–51

    Article  PubMed  CAS  Google Scholar 

  7. Denning DW, Donnelly JP, Hellreigel KP, et al. Antifungal prophylaxis during neutropenia or allogeneic bone marrow transplantation: what is the state of the art? Chemotherapy 1992; 38 Suppl. 1: 43–9

    Article  PubMed  Google Scholar 

  8. Milliken ST, Powles RL. Antifungal prophylaxis in bone marrow transplantation. Rev Infect Dis 1990; 12 Suppl. 3: S374–9

    Article  Google Scholar 

  9. Lopez-Berestein G, Feinstein V, Hopfer R, et al. Liposomal amphotericin-B for the treatment of systemic fungal infections in patients with cancer: a preliminary study. J Infect Dis 1985; 151 (4): 704–10

    Article  PubMed  CAS  Google Scholar 

  10. Meunier-Carpentier F. Chemoprophylaxis of fungal infections. Am J Med 1984; 76: 652–6

    Article  PubMed  CAS  Google Scholar 

  11. O’Donnell MR, Schmidt GM, Tegtmeier BR, et al. Prediction of systemic fungal infection in allogeneic marrow recipients: impact of amphotericin prophylaxis in high-risk patients. J Clin Oncol 1994; 12 (4): 827–34

    PubMed  Google Scholar 

  12. Beecham J. Costing services: an update. Discussion Paper 844. Canterbury: University of Kent, 1992

    Google Scholar 

  13. Monthly index of medical specialities. London: Haymarket Medical, 1992 Nov

  14. Clark CM, Bailie GR, Whitaker AM, et al. Parenteral drug delivery — value for money? Pharm J 1986; 236: 453–5

    Google Scholar 

  15. Review body for nursing staff, midwives, health visitors and professions allied to medicine. Ninth report on nursing staff, midwives and health visitors. Command Paper 1811. London: House of Commons, 1992

    Google Scholar 

  16. Her Majesty’s Treasury. Discount rates in the public sector. London: Press Office, 1989

    Google Scholar 

  17. Royal Marsden Hospital Special Health Authority Financial Return FRll, 1991

  18. Reents S, Goodwin SG, Singh V. Antifungal prophylaxis in immunocompromised hosts. Ann Pharmacother 1993; 27: 53–60

    PubMed  CAS  Google Scholar 

  19. Tollemar J, Ringdéen O, Andersson S, et al. Prophylactic use of liposomal amphotericin-B (AmBisome) against fungal infections: a randomized trial in bone marrow transplant recipients. Transplant Proc 1993; 25 (1): 1495–7

    PubMed  CAS  Google Scholar 

  20. Wingard JR, Merz WG, Rinaldi MG, et al. Increase in Candida krusei infection among patients with bone marrow transplantation and neutropenia treated prophylactically with fluconazole. N Engl J Med 1991; 325: 1274–7

    Article  PubMed  CAS  Google Scholar 

  21. Sangeorzan JA. Antifungal prophylaxis in bone marrow transplantation. Resident and Staff Physician 1991 Oct; 21–5

  22. Prentice HG, Kibbler CC, McWhinney P. Antimicrobial prophylaxis and treatment after chemotherapy or marrow transplantation. In: Hoffbrand AV, Brenner M, editors. Recent advances in haematology. London: Churchill Livingstone, 1992: 173–94

    Google Scholar 

  23. Chopra R, Fielding A, Goldstone AH. Successful treatment of fungal infections in neutropenic patients with liposomal amphotericin B (AmBisome) — a report on 40 cases from a single centre. Leuk Lymphoma 1992; 7 Suppl.: 73–7

    Article  PubMed  Google Scholar 

  24. Cox DR, Oakes D. Analysis of survival data. London: Chapman and Hall, 1984

    Google Scholar 

  25. Fenn P, Davies P. Note: variations in length of stay. A conditional likelihood approach. J Health Econ 1990; 9: 223–34

    Article  PubMed  CAS  Google Scholar 

  26. Briggs A, Sculpher M, Buxton M. Uncertainty in the economic evaluation of health care technologies: the role of sensitivity analysis. Health Econ 1994; 3: 95–104

    Article  PubMed  CAS  Google Scholar 

  27. Parker SE, Davey PG. Pharmacoeconomics of intravenous drug administration. PharmacoEconomics 1992; 1 (2): 103–15

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Personal Social Services Research Unit/Canterbury Business School, University of Kent at Canterbury, Canterbury, Kent, CT2 7NF, England

    Alan Stewart

  2. Royal Marsden National Health Service Trust, Sutton, Surrey, England

    Ray Powles, Margaret Hewetson, Judy Antrum, Celia Richardson & Jayesh Mehta

Authors
  1. Alan Stewart
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ray Powles
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Margaret Hewetson
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Judy Antrum
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Celia Richardson
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Jayesh Mehta
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Stewart, A., Powles, R., Hewetson, M. et al. Costs of Antifungal Prophylaxis After Bone Marrow Transplantation. Pharmacoeconomics 8, 350–361 (1995). https://doi.org/10.2165/00019053-199508040-00009

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.2165/00019053-199508040-00009

Keywords

Search

Navigation