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

Autor:	Gisele Balan, Roberto Pontarolo, Bruno Salgado Riveros, Fernanda S. Tonin, Laiza M Steimbach, Vinicius Lins Ferreira, Bruna Q. Bagatim, Helena Hiemisch Lobo Borba, Astrid Wiens
Rok vydání:	2018
Předmět:	0301 basic medicine medicine.medical_specialty Antifungal Agents Cost effectiveness Cost-Benefit Analysis 030106 microbiology Dermatology 03 medical and health sciences Amphotericin B medicine Humans Clinical efficacy Intensive care medicine Sensitivity analyses business.industry General Medicine Health states 030104 developmental biology Infectious Diseases Resource use Liposomal amphotericin business Amphotericin B-Lipid Complex Brazil Invasive Fungal Infections medicine.drug
Zdroj:	Mycoses. 61:754-763
ISSN:	0933-7407
DOI:	10.1111/myc.12801
Popis:	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.
Databáze:	OpenAIRE
Externí odkaz:	https://explore.openaire.eu/search/publication?articleId=doi_dedup___::f4c3eb63bc5c5377bcb7992a98880518 https://doi.org/10.1111/myc.12801 Zobrazit plný text záznamu Plný text ve formátu PDF Plný text ve formátu HTML
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