Treatment of immunocompromised patients with suspected invasive fungal infections: economic analysis of diagnostic-driven versus empirical strategies in Algeria and Egypt

ABSTRACT

Background: Invasive fungal infections (IFIs) in immunocompromised patients are associated with high mortality and treatment costs. Identifying appropriate, cost-effective treatment strategies is crucial to reduce the burden of IFIs. This economic assessment compared strategies for treating immunocompromised patients in Algeria and Egypt.

Methods: We developed a decision analytic model incorporating clinical and cost inputs associated with a diagnostic-driven (DD) and standard empirical (SE) strategy. Costs and clinical outcomes were used to calculate incremental cost-effectiveness ratios (ICERs) per death avoided.

Results: In both countries, 73.8 (DD) and 125.3 (SE) hypothetical patients per 1,000 received antifungal therapy; 73.8 (DD) and 32.7 (SE) had diagnosed IFIs. Survival at 180 days was similar between DD and SE strategies in Algeria (92.0% vs 91.6%) and Egypt (90.2% vs 90.0%). Total costs per patient were lower with the DD than SE strategy (Algeria: $839 vs $1,591; Egypt: $4,077 vs $4,717). ICERs indicated that the DD compared with SE strategy was associated with better clinical outcomes at a lower overall cost in both countries.

Conclusion: Diagnostic-driven compared to empirical therapy may be cost-saving in Algeria and Egypt for the management of immunocompromised patients with persistent neutropenic fever, with no increase in mortality.

KEYWORDS:

• Invasive fungal infection
• cost-effectiveness
• voriconazole
• caspofungin
• itraconazole
• amphotericin B

Acknowledgments

The authors would like to thank Nacer Eddine Mami who was an employee of Pfizer at the time of the study and contributed to the analyses and interpretation of data.

Declaration of interest

X Gao and M Xue are employees of Pharmerit International, who were paid consultants to Pfizer in connection with the development of this manuscript. SA Belkacem, AGA Ibrahim, R Kotb, and C Charbonneau are employees of Pfizer. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Author contributions

All authors were involved in the conception and design, data analysis and interpretation, the drafting of the article, and critical revision of the manuscript for intellectual content. All authors gave the final approval of the version to be published and agree to be accountable for all aspects of the work.

Additional information

Funding

This study was sponsored by Pfizer. Medical writing support was provided by Martin Bell at Complete Medical Communications and was funded by Pfizer.