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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.
Acknowledgments
Interim findings for the Shanghai analyses were presented at the ISPOR 17th Annual European Congress, November 8–12, 2014, in Amsterdam, the Netherlands, as a poster presentation. The abstract for this presentation is available on http://www.valueinhealthjournal.com/article/S1098-3015(14)04409-X/pdf. Interim findings for the Beijing, Chengdu, and Guangzhou analyses were presented at the 2015 ISPOR Annual International Meeting, May 16–20, 2015, in Philadelphia, PA, USA, as a poster presentation. The abstract of this poster is available on https://www.rti.org/publications/abstract.cfm?pubid=24212.
Disclosure
Financial support for this study was provided through a grant from Pfizer Investment Co. Ltd., Beijing, People’s Republic of China. The funding agreement ensured the authors’ independence in designing the study, interpreting the data, and writing and publishing the report. Yixi Chen and Claudie Charbonneau are employed by the sponsor. The authors report no other conflicts of interest in this work.