Microsoft powerpoint - isham 2006 poster - mycamine cea 061506.ppt

Cost-Effectiveness Analysis of Anti-Fungal Prophylaxis in Patients
Undergoing Hematopoietic Cell Transplantation
Raafat Seifeldin, PharmD PhD 1; Warren Schonfeld, PhD 2; Jason W Cheng 2
1 Astellas Pharma US Inc., Deerfield, IL; 2 Quorum Consulting, Inc., San Francisco, CA
Prophylaxis can decrease the incidence of fungal infections in To test the variability of the results using repeated sampling, a transplant patients and lower the overall cost of care by reducing bootstrapping analysis was also conducted, with 1,000 Figure 1. Scatterplot of bootstrapping analysis
the number and cost of infections needing treatment. In a multi- simulations of random samples of 100 patients from each center, blinded, randomized head-to-head comparative study treatment group. If appropriate to describe the results, evaluating the safety and efficacy of prophylaxis in 882 incremental cost-effectiveness ratios were calculated, and hematopoietic stem cell transplant (HSCT) patients, micafungin sensitivity analyses were conducted by varying components of was shown to be more effective than fluconazole in preventing Difference in mean effectiveness
suspected fungal infection (84.9% vs 78.6%).
Mean cost for a course of prophylactic drug therapy was $2,018 An economic analysis was conducted to evaluate the cost- for the 425 patients treated with micafungin and $843 for the 457 effectiveness of micafungin prophylaxis compared to fluconazole c
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prophylaxis among patients undergoing HSCT. Table 2. Results of baseline analysis for HSCT
The high concentration of results in Quadrant IV, where average costs are lower and average effectiveness is greater for micafungin, indicates the dominance of micafungin prophylaxis.
Cost-effectiveness measures were calculated to compare (1) prophylaxis with micafungin versus (2) prophylaxis with Sensitivity analyses on estimated hospital costs confirmed the fluconazole. Efficacy data were taken from the clinical study, in superiority of micafungin as a cost-effective therapy. which the incidence of proven or probable systemic fungal infections was 1.6% in the micafungin treatment arm and 2.4% in the fluconazole treatment arm. The percentage of patients Table 3. Results of sensitivity analysis for HSCT
receiving empiric therapy was 15.1% and 21.4% for micafungin and fluconazole, respectively. The economic analysis was conducted from the hospital perspective using costs incurred Baseline results
Positive (negative) dollar amounts indicate that micafungin costs are more (less) than fluconazolecosts; positive effectiveness value indicates that micafungin is more effective than fluconazole.
from admission through discharge. Each of the 882 patients was 2 Effectiveness is assigned by the presence or absence of a proven fungal infection - with a fungal assigned costs and effectiveness based on their outcomes data infection = 0 and without a fungal infection = 1.
Sensitivity analysis #1: Price per mg of micafungin increased by 50%
from the clinical study. Published literature was used to estimate hospital costs (adjusted to 2005 values) associated with HSCT Micafungin Dominant
patients receiving prophylaxis, empiric anti-fungal treatment, and Sensitivity analysis #2: Hospital costs of fungal infection = successful empiric therapy
treatment for a probable or proven Candida or Aspergillus infection. Mean costs and effectiveness were calculated for 3 ICER obtained by dividing difference in total hospital costs by difference in average effectiveness.
Sensitivity analysis #3: Hospital costs of empiric therapy = successful prophylaxis
Adding in other hospital costs, total patient costs were $114,251 Table 1. Baseline analysis variables
and $117,821 for micafungin and fluconazole patients, 1 Negative dollar amounts indicate that micafungin costs are less than fluconazole costs.
respectively, a significant difference of $3,570 (p=0.015). Cost of drugs for prophylaxis ($ per mg) 1 Considering the lower rate of breakthrough fungal infection from the clinical study, micafungin is the dominant method of prophylaxis, with both lower costs and greater efficacy. The In addition to its greater efficacy, micafungin prophylaxis for Estimated hospital costs per HSCT patient 2,3 bootstrapping analysis indicated that micafungin prophylaxis was patients undergoing HSCT leads to cost savings compared to cost saving in 72.4% of the samples compared to 9.2% for fluconazole prophylaxis. Despite the higher costs of the drug fluconazole prophylaxis. Micafungin prophylaxis was dominant in itself, prophylaxis with micafungin reduces total hospital costs by 55.5% of the samples, compared to 6.4% for fluconazole $3,570 per patient, due to less need for empirical anti-fungal Values adjusted to 2005 dollars. (Bureau of Labor Statistics, U.S. Department of Labor, CPI - All Urban Consumers, U.S. City therapy and fewer proven or probable fungal infections.
1 Red Book. Montvale, NJ: Medical Economics Co Inc; 2005.
2 Cagnoni PJ, Walsh TJ, Prendergast MM et al. Pharmacoeconomic analysis of liposomal amphotericin B versus conventional amphotericin B in the empirical treatment of persistently febrile neutropenic patients. J Clin Oncol. 2000 Jun;18(12):2476-83.
3 Wilson LS, Reyes CM, Stolpman M et al. The direct cost and incidence of systemic fungal infections. Value Health. 2002

Source: http://www.quorumconsulting.com/docs/2006_ISHAM.pdf