Pharmacoeconomic analysis of liposomal amphotericin B versus conventional amphotericin B in the empirical treatment of persistently febrile neutropenic patients

Purpose: In a randomized, double-blind, comparative, multicenter trial, lip osomal amphotericin B was equivalent to conventional amphotericin a for emp irical antifungal therapy in febrile neutropenic patients, using a composit e end paint, but was more effective in reducing proven emergent fungal infe ctions, infusion-related toxicities, and nephrotoxicity, The purpose of thi s study was to compare the pharmacoeconomics of liposomal versus convention al therapy. Patients and Methods: Itemized hospital billing data were collected on 414 patients from 19 of the 32 centers that participated in the trial. Hospital length of stay and costs from the first dose of study medication to the ri me of hospital discharge were assessed. Results: Hospital costs from the time of first dose to discharge were signi ficantly higher for all patients who received liposomal amphotericin B ($48 ,962 v $43,183; P = .022). However, hospital costs were highly sensitive to the cost of study medication ($39,648 v $43,048 when drug costs were not i ncluded; P = .416). Using decision analysis models and sensitivity analyses to vary the cost of study medications and the risk of nephrotoxicity, the break-even points for the cost of liposomal therapy were calculated to rang e from $72 to $87 per 50 mg for all patients and $83 to $112 per 50 mg in a llogeneic bone marrow transplant patients, Conclusion: The cost of liposomal amphotericin B and patient risk for devel oping nephrotoxicity piety large roles in determining whether liposomal amp hotericin B is cast-effective as first-line empirical therapy in persistent ly febrile neutropenic patients. J Clin Oncol 18:2476-2483. (C) 2000 by Ame rican Society of Clinical Oncology.