Pharmacoeconomics of empirical antifungal use in febrile neutropenic hematological malignancy and hematopoietic stem cell transplant patients

Abstract

Invasive fungal infections incur considerable costs to healthcare and are associated with high mortality. These infections are increasing, due in part to more intensive immunosuppressive regimens with longer periods of neutropenia for patients treated for conditions such as cancer and hematopoietic stem cell transplantation. Therapeutic strategies in treating invasive fungal infections include the initiation of empiric antifungal therapy. This early treatment is triggered by fever that is unresponsive to 48–72 h of broad-spectrum antibiotic therapy in high-risk patients, prior to diagnosis. Several antifungal agents are available for this purpose. Informed decisions with respect to the choice of antifungal drug require clinicians to consider both efficacy data of a particular drug and the economic consequences of using the drug. This enables a treatment decision to be based not only on drug acquisition cost, but also expenses associated with hospitalization, monitoring and managing adverse effects to the treatment(s) chosen.

Keywords::

• antifungal
• caspofungin
• cost
• empiric therapy
• febrile neutropenia
• invasive fungal infection
• liposomal amphotericin B
• pharmacoeconomics
• voriconazole

Acknowledgements

This article has greatly benefited from the review and advice of Jack Brown, PharmD, MS, BCPS.

Financial & competing interests disclosure

SCA Chen and MA Slavin have sat on advisory boards for and received research funding (unrelated to this work) from Pfizer, Merck, Schering-Plough and Gilead Sciences. DCM Kong has sat on the advisory board for Pfizer and received financial support (not related to the current work) from Pfizer, Merck and Gilead Sciences. 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.

No writing assistance was utilized in the production of this manuscript.