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

Authors Mao N, Lesher B, Liu Q, Qin L, Chen Y, Gao X, Earnshaw S, McDade C, Charbonneau C

Received 21 November 2015

Accepted for publication 9 February 2016

Published 14 June 2016 Volume 2016:8 Pages 275—285

DOI https://doi.org/10.2147/CEOR.S101015

Checked for plagiarism Yes

Review by Single-blind

Peer reviewers approved by Dr Michael Liebman

Peer reviewer comments 2

Editor who approved publication: Professor Giorgio Lorenzo Colombo

Ningying Mao,1 Beth Lesher,2 Qifa Liu,3 Lei Qin,2 Yixi Chen,4 Xin Gao,2 Stephanie R Earnshaw,5 Cheryl L McDade,5 Claudie Charbonneau,6

1School of International Pharmaceutical Business, China Pharmaceutical University, Nanjing, People's Republic of China; 2Pharmerit International, Bethesda, MD, USA; 3Hematology Department, Nanfang Hospital, Southern Medical University, Guangzhou, 4Pfizer Investment Co. Ltd., Beijing, People's Republic of China; 5RTI Health Solutions, Research Triangle Park, NC, USA; 6Pfizer International Operations, Paris, France

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, cost-effectiveness analysis, voriconazole, caspofungin, itraconazole

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