Cost-effectiveness of amphotericin B formulations in the treatment of systemic fungal infections.

Abstract:

:Amphotericin formulations, indicated for invasive fungal infections (IFIs), vary in effectiveness, safety and costs. In Brazil, only the conventional formulation is provided by the Public Health System. The aim of this study was to perform a cost-effectiveness analysis comparing conventional amphotericin B (CAB), liposomal amphotericin B (LAB) and amphotericin B lipid complex (ABLC). Therefore, a decision tree was developed. The model began with high-risking patients on suspicion or confirmation of IFI. The analysis was conducted under the perspective of the Brazilian Public Health System. Model health states were defined according to medication use and clinical evolution. Clinical efficacy (cure) and transition probabilities were derived from the literature. Resource use was estimated from Brazilian data. Time horizon followed the maximum treatment time determined in the patient information leaflets (3 or 6 weeks). One-way and probabilistic-sensitivity analyses were conducted. The conventional formulation was the most cost-effective. No dominance was observed; however, high incremental cost-effectiveness ratios were obtained for LAB (USD 313 130) and ABLC (USD 1 711 280). Sensitivity analyses demonstrated the robustness of the results. CAB is the most cost-effective treatment, followed by LAB and ABLC. Although CAB presents critical safety aspects, the high acquisition costs of the other formulations prevent their large-scale use in Brazil.

journal_name

Mycoses

journal_title

Mycoses

authors

Borba HHL,Steimbach LM,Riveros BS,Tonin FS,Ferreira VL,Bagatim BAQ,Balan G,Pontarolo R,Wiens A

doi

10.1111/myc.12801

subject

Has Abstract

pub_date

2018-10-01 00:00:00

pages

754-763

issue

10

eissn

0933-7407

issn

1439-0507

journal_volume

61

pub_type

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