Economic Comparison of an Empirical Versus Diagnostic-Driven Strategy for Treating Invasive @entity364 in Immunocompromised XXXX .

@entity1 @entity3129 @entity2379 @entity1398 @entity364 @entity5074 @entity11794
PURPOSE: @entity1 with persistent or recurrent @entity1398 fevers at risk of @entity364 ( @entity364 ) are treated empirically with antifungal therapy (AFT). Early treatment using a @entity3129 ( @entity3129 ) strategy may reduce clinical and economic burdens. We compared costs and outcomes of both strategies from a UK perspective. METHODS: An empirical strategy with conventional @entity2379 deoxycholate (C-AmB), liposomal @entity2379 (L-AmB), or @entity11794 was compared with a @entity3129 strategy (initiated based on positive ELISA results for galactomannan antigen) and/or positive results for Aspergillus species on polymerase chain reaction assay) using C-AmB, @entity5074 , or L-AmB in a decision-analytic model. Rates of @entity364 incidence, overall mortality, and @entity364 -related mortality in adults expected to be @entity1398 for >= 10  days were obtained. The empirical strategy was assumed to identify 30% of @entity364 and targeted AFT to improve survival by a hazard ratio of 0.589. AFT-specific adverse events were obtained from a summary of product characteristics. Resource use was obtained, and costs were estimated by using standard UK costing sources. All costs are presented in 2012 British pounds sterling. FINDINGS: Total costs were 32% lower for the @entity3129 strategy (  1561.29) versus the empirical strategy (  2301.93) due to a reduced incidence of adverse events and decreased use of AFT. Administration of AFT was reduced by 41% ( @entity3129 strategy, 74 of 1000; empirical strategy, 125 of 1000), with similar survival rates. IMPLICATIONS: This study suggests that a @entity3129 strategy is likely to be cost-saving versus empirical treatment for immunocompromised @entity1 with persistent or recurrent @entity1398 fevers.
