FLUCONAZOLE VERSUS ORAL POLYENES IN THE PROPHYLAXIS OF IMMUNOCOMPROMISED PATIENTS - A COST-MINIMIZATION ANALYSIS

This study compares 100 mg daily fluconazole with oral polyenes four t imes daily in the prophylaxis of fungal infections in immunocompromise d patients, to determine a cost-minimization strategy. Data was gather ed through a literature survey and clinical interviews conducted in ni ne different UK hospitals. This was used to construct a decision tree, modelling the drug choices available to a clinician at various stages of a patient's treatment, and assigning probabilities to the differen t corresponding outcomes. UK cost data were fed into this model to det ermine the expected cost per patient of the different prophylaxis stra tegies. Two different patient groups were considered: chemotherapy-onl y patients, and bone-marrow-transplant (BMT) patients who have higher risks of fungal infection. Probabilities derived from the literature s uggest that a cost-minimization strategy to manage both chemotherapy p atients and BMT patients is to administer oral fluconazole, both as pr ophylaxis and as first line treatment, against superficial fungal infe ction. Probabilities gathered from clinical interviews yield similar r esults, suggesting that the cost-minimization strategy with chemothera py-only patients is to administer oral polyenes as prophylaxis, and or al fluconazole in case of superficial fungal infection, while for BMT patients it is a combination of fluconazole and oral polyenes as proph ylaxis, with oral fluconazole for the treatment of superficial fungal infections. Using the probabilities from the literature, the lowest co st strategies produce an expected cost of pound 567.20 for chemotherap y-only patients, and an expected cost of pound 804.87 for BMT patients for a course of treatment lasting from seven to 28 days. The clinical interview probabilities produce expected costs of pound 826.48 and po und 1529.43, respectively. Sensitivity analysis was then conducted, an d it was found that in the majority of cases, using the literature pro babilities, the cost-minimizing strategy remained prophylaxis with ora l fluconazole. The sensitivity analysis for chemotherapy-only patients using the interview probabilities tended to favour oral polyenes as t he cost-minimization strategy, whereas for BMT patients the sensitivit y analysis favoured a combination of fluconazole and oral polyenes in the majority of cases. The key economic advantage of prophylaxis with fluconazole or a combination of fluconazole with oral polyenes in the prophylaxis of fungal infection in immunocompromised patients, results from the reduction of the expected cost of subsequent fungal infectio n among those who are most at risk.