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Pharmacoeconomic Analysis of Liposomal Amphotericin B Versus Conventional Amphotericin B in the Empirical Treatment of Persistently Febrile Neutropenic Patients

From the Bone Marrow Transplant Program, University of Colorado Health Sciences Center, Denver, CO; Immunocompromised Host Section, National Cancer Institute, Bethesda, MD; Fujisawa Healthcare Inc, Deerfield, IL; Division of Hematology and Bone Marrow Transplantation, University of Kansas Medical Center, Kansas City, MO; H. Lee Moffitt Cancer Center, University of South Florida, Tampa, FL; Division of Infectious Diseases, University of Kentucky, Lexington, KY; Division of Pediatric Hematology-Oncology, Mayo Clinic, Rochester, MN; Division of Infectious Diseases, University of Pennsylvania, Philadelphia, PA; Division of Hematology-Oncology, Children’s National Medical Center, Washington, DC; Division of Infectious Diseases, Loyola University Medical Center, Maywood, IL; and Quorum Consulting, Inc, San Francisco, CA.

Address reprint requests to Kuo B. Tong, MS, Quorum Consulting, Inc, 442 Post St, Ninth Floor, San Francisco, CA 94102-1510; email ktong{at}quonet.com

PURPOSE: In a randomized, double-blind, comparative, multicenter trial, liposomal amphotericin B was equivalent to conventional amphotericin B for empirical antifungal therapy in febrile neutropenic patients, using a composite end point, but was more effective in reducing proven emergent fungal infections, infusion-related toxicities, and nephrotoxicity. The purpose of this study was to compare the pharmacoeconomics of liposomal versus conventional therapy.

PATIENTS AND METHODS: Itemized hospital billing data were collected on 414 patients from 19 of the 32 centers that participated in the trial. Hospital length of stay and costs from the first dose of study medication to the time of hospital discharge were assessed.

RESULTS: Hospital costs from the time of first dose to discharge were significantly higher for all patients who received liposomal amphotericin B ($48,962 v $43,183; P = .022). However, hospital costs were highly sensitive to the cost of study medication ($39,648 v $43,048 when drug costs were not included; P = .416). Using decision analysis models and sensitivity analyses to vary the cost of study medications and the risk of nephrotoxicity, the break-even points for the cost of liposomal therapy were calculated to range from $72 to $87 per 50 mg for all patients and $83 to $112 per 50 mg in allogeneic bone marrow transplant patients.

CONCLUSION: The cost of liposomal amphotericin B and patient risk for developing nephrotoxicity play large roles in determining whether liposomal amphotericin B is cost-effective as first-line empirical therapy in persistently febrile neutropenic patients.

Presented in part at the Eighth Annual Meeting, Focus on Fungal Infections, Orlando, FL, March 4-6, 1998, and the Thirty-Fifth Annual Meeting of the American Society of Clinical Oncology, Atlanta, GA, May 15-18, 1999.

M.M.P. is an employee of Fujisawa Healthcare Inc; P.J.C., D.B., S.H., R.N.G., M.S., and K.B.T. have served as paid consultants to Fujisawa Healthcare Inc.

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