Cost-effectiveness analysis of micafungin versus fluconazole for prophylaxis of invasive fungal infections in patients undergoing hematopoietic stem cell transplantation in Korea

Abstract: Background: Invasive fungal infections are often fatal complications in patients undergoing hematopoietic stem cell transplantation (HSCT), and prophylactic antifungal treatment has been recommended. Within budget-limited health care environments, choosing a cost-effective drug is very important. Objective: This study was conducted to analyze the cost-effectiveness of micafungin and fluconazole for prophylaxis of invasive fungal infections from the payer''s perspective in patients undergoing HSCT in a Korean health care setting. Methods: We constructed a decision-analytic model to evaluate both total costs for each state of health and outcomes (such as the fungal-infection prevention rate and life expectancy) for 2 alternatives in a hypothetical cohort of 100 patients undergoing HSCT. The target population was aged 43 years, weighed >50 kg, and had normal renal function. For prophylaxis against systemic fungal infections, patients were administered either micafungin 50 mg/d or fluconazole 400 mg/d, without dose adjustment, as a 1-hour infusion for a mean of 19 consecutive days. Depending on the clinical outcomes with prophylactic therapy, different treatments were assumed. Patients with proven/ probable fungal infection received acute antifungal therapy, and those with suspected fungal infection received empiric antifungal therapy. All patients received general medical care during the analysis period. Results are expressed as Korean won (KW; US $1 = KW 925 as of December 1, 2007). Results: The base-case analysis found that mica-fungin treatment, compared with fluconazole, saved KW 95,511,000, increased the number of infection-free patients by 0.5, and saved 4.8 life-years per 100 patients. Results with micafungin as the dominant strategy were found to be robust in sensitivity analyses for several parameters, including treatment success and failure rates; mortality risk ratio; and costs for general care, empiric therapy, and acute antifungal therapy. Conclusion: Micafungin was a cost-effective prophylactic antifungal strategy by providing lower medical costs and longer life expectancy than fluconazole from the payer''s perspective in a hypothetical cohort of Korean adults undergoing HSCT. [Copyright &y& Elsevier]