Economic evaluation of a preemptive treatment strategy for invasive fungal infection in neutropenic patients with hematological diseases

S. I. Kimura, T. Murata, Y. Akahoshi, H. Nakano, T. Ugai, H. Wada, R. Yamasaki, Y. Ishihara, K. Kawamura, K. Sakamoto, M. Ashizawa, M. Sato, K. Terasako-Saito, H. Nakasone, M. Kikuchi, Rie Yamazaki, S. Kako, J. Kanda, A. Tanihara, J. NishidaY. Kanda

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

We compared the expected medical costs of empirical and preemptive treatment strategies for invasive fungal infection in neutropenic patients with hematological diseases. Based on the results of two clinical trials with different backgrounds reported by Oshima et al. [J Antimicrob Chemother 60(2):350–355; Oshima study] and Cordonnier et al. [Clin Infect Dis 48(8):1042–1051; PREVERT study], we developed a decision tree model that represented the outcomes of empirical and preemptive treatment strategies, and estimated the expected medical costs of medications and examinations in the two strategies. We assumed that micafungin was started in the empirical group at 5 days after fever had developed, while voriconazole was started in the preemptive group only when certain criteria, such as positive test results of imaging studies and/or serum markers, were fulfilled. When we used an incidence of positive test results of 6.7 % based on the Oshima study, the expected medical costs of the empirical and preemptive groups were 288,198 and 150,280 yen, respectively. Even in the case of the PREVERT study, in which the incidence of positive test results was 32.9 %, the expected medical costs in the empirical and preemptive groups were 291,871 and 284,944 yen, respectively. A sensitivity analysis indicated that the expected medical costs in the preemptive group would exceed those in the empirical group when the incidence of positive test results in the former was over 34.4 %. These results suggest that a preemptive treatment strategy can be expected to reduce medical costs compared with empirical therapy in most clinical settings.

Original languageEnglish
Pages (from-to)951-961
Number of pages11
JournalEuropean Journal of Clinical Microbiology and Infectious Diseases
Volume34
Issue number5
DOIs
Publication statusPublished - 2015 May 1
Externally publishedYes

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Hematologic Diseases
Cost-Benefit Analysis
Costs and Cost Analysis
Incidence
Therapeutics
Decision Trees
Invasive Fungal Infections
Fever
Biomarkers
Clinical Trials

ASJC Scopus subject areas

  • Microbiology (medical)
  • Infectious Diseases

Cite this

Economic evaluation of a preemptive treatment strategy for invasive fungal infection in neutropenic patients with hematological diseases. / Kimura, S. I.; Murata, T.; Akahoshi, Y.; Nakano, H.; Ugai, T.; Wada, H.; Yamasaki, R.; Ishihara, Y.; Kawamura, K.; Sakamoto, K.; Ashizawa, M.; Sato, M.; Terasako-Saito, K.; Nakasone, H.; Kikuchi, M.; Yamazaki, Rie; Kako, S.; Kanda, J.; Tanihara, A.; Nishida, J.; Kanda, Y.

In: European Journal of Clinical Microbiology and Infectious Diseases, Vol. 34, No. 5, 01.05.2015, p. 951-961.

Research output: Contribution to journalArticle

Kimura, SI, Murata, T, Akahoshi, Y, Nakano, H, Ugai, T, Wada, H, Yamasaki, R, Ishihara, Y, Kawamura, K, Sakamoto, K, Ashizawa, M, Sato, M, Terasako-Saito, K, Nakasone, H, Kikuchi, M, Yamazaki, R, Kako, S, Kanda, J, Tanihara, A, Nishida, J & Kanda, Y 2015, 'Economic evaluation of a preemptive treatment strategy for invasive fungal infection in neutropenic patients with hematological diseases', European Journal of Clinical Microbiology and Infectious Diseases, vol. 34, no. 5, pp. 951-961. https://doi.org/10.1007/s10096-014-2311-8
Kimura, S. I. ; Murata, T. ; Akahoshi, Y. ; Nakano, H. ; Ugai, T. ; Wada, H. ; Yamasaki, R. ; Ishihara, Y. ; Kawamura, K. ; Sakamoto, K. ; Ashizawa, M. ; Sato, M. ; Terasako-Saito, K. ; Nakasone, H. ; Kikuchi, M. ; Yamazaki, Rie ; Kako, S. ; Kanda, J. ; Tanihara, A. ; Nishida, J. ; Kanda, Y. / Economic evaluation of a preemptive treatment strategy for invasive fungal infection in neutropenic patients with hematological diseases. In: European Journal of Clinical Microbiology and Infectious Diseases. 2015 ; Vol. 34, No. 5. pp. 951-961.
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AU - Ugai, T.

AU - Wada, H.

AU - Yamasaki, R.

AU - Ishihara, Y.

AU - Kawamura, K.

AU - Sakamoto, K.

AU - Ashizawa, M.

AU - Sato, M.

AU - Terasako-Saito, K.

AU - Nakasone, H.

AU - Kikuchi, M.

AU - Yamazaki, Rie

AU - Kako, S.

AU - Kanda, J.

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AU - Nishida, J.

AU - Kanda, Y.

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