The expenditures related to the use of antifungal drugs in patients with hematological cancers: a cost analysis

Figures & data

Table 1 Hematological malignancies of the patients

Hematological malignancies	n (%)
Acute myeloblastic leukemia	73 (58)
Acute lymphocytic leukemia	22 (17)
Non-Hodgkin lymphoma	7 (5)
Chronic lymphocytic leukemia	5 (4)
Multiple myeloma	5 (4)
Hairy cell leukemia	4 (3)
Aplastic anemia	3 (2)
Chronic myeloid leukemia	2 (2)
Plasma cell leukemia	2 (2)
Mantle cell lymphoma	2 (2)
Chronic lymphocytic leukemia with Burkitt’s lymphoma	1 (1)
Total	126 (100)

Table 2 Fungal pathogens and treatment responses of the patients with bloodstream infections

Patient	Age (years)	Sex	Hematological malignancy	Sample	Fungal pathogen	Antifungal resistance	History of azole exposure	Empirical antifungal treatment before identification	Treatment modification	Outcome
1	32	Male	AML	Blood	Candida parapsilosis	VOR, FLC	+	CAS	–	Survived
				Blood	C. parapsilosis	VOR, FLC	+	CAS	–	Survived
				Blood	C. glabrata	FLC	+	L-AmB	Central line removed	Survived
2	51	Male	AML	Blood	C. parapsilosis	VOR, FLC	+	CAS	Central line removed	Survived
				Blood, wound	C. parapsilosis	VOR, FLC	+	VOR	From VOR to AmB	Died
3	32	Male	AML	Blood	C. parapsilosis	VOR, FLC	+	CAS	–	Survived
				Blood	C. parapsilosis	VOR, FLC	+	VOR	From VOR to L-AmB	Survived
4	52	Female	ALL	Blood	Geotrichum capitatum	FLC, ITR	−	CAS	Central line removed	Survived
				Blood	G. capitatum	FLC, ITR	+	VOR	–	Died
5	60	Female	ALL	Blood	C. albicans	VOR, ITR, FLC	−	CAS	–	Survived
6	21	Female	Aplastic anemia	Blood	C. albicans		−	CAS	–	Survived
7	33	Male	AML	Blood	G. capitatum	FLC	−	VOR	Central line removed	Survived
8	55	Female	AML	Blood	Trichosporon asahii	AmB	+	CAS	Central line removed	Died
9	63	Female	AML	Blood	T. asahii	AmB	+	L-AmB	From AmB to VOR, central line removed	Died
10	45	Female	AML	Blood	T. asahii	AmB, ITR	−	CAS	Empirically switched to VOR	Died
11	50	Male	AML + lung cancer	Blood	C. parapsilosis		+	VOR	From VOR to AmB, central line removed	Survived
				Blood	C. albicans		+	VOR	–	Survived
12	62	Female	AML	Blood, sputum	C. parapsilosis		+	VOR	From VOR to CAS, central line removed	Died
13	61	Male	AML	Blood, urine	C. albicans		+	CAS		Died
14	73	Female	NHL	Blood, central line	C. albicans		+	L-AmB	Central line removed	Survived
15	35	Male	AML	Blood	C. albicans		+	CAS		Survived
16	44	Female	ALL	Blood	C. albicans		+	L-AmB		Survived
17	63	Female	AML	Blood	C. krusei		+	VOR	–	Survived
18	51	Female	AML	Blood	C. albicans		+	VOR	–	Survived

Abbreviations: ALL, acute lymphocytic leukemia; AML, acute myeloblastic leukemia; AmB, amphotericin B; CAS, caspofungin; FLC, fluconazole; ITR, itraconazole; L-AmB, liposomal amphotericin B; NHL, non-Hodgkin lymphoma; VOR, voriconazole.

Table 3 Antimicrobials and their costs

Antifungal drugs	DDD	PDD/100 patient days	Mean DDD per month	Range of DDD per month	Mean cost per month (US$)	Range of costs per month (US$)	Total cost per year (US$)
Amphotericin B (standard)	35 mg	0.08	16.04	0–34.28	39.06	0–880.43	187.12
Voriconazole (tablet form)	0.4 g	0.42	162.53	6–244	2,796.11	266.46–5,447.22	34,951.42
Voriconazole (intravenous form)	0.4 g	0.15	32.12	0–118	14,178.42	0–50,999.94	177,230.33
Posaconazole	0.8 g	0.09	34.28	5–70	4,482.97	0–880.43	337,757.63
Caspofungin	50 mg	0.28	56.62	13.4–154.4	28,410.01	6,954.5–87,220.58	355,125.15
Liposomal amphotericin B	250 mg	0.21			29,322.98	0–82,261.44	366,537.43
Total							1,271,789.08

Abbreviations: DDD, defined daily dose; PDD, patient daily dose.