Antifungal Pharmacoeconomics in Hematologic Cancer and HSCT
Caspofungin and LAmB have displayed similar efficacy in empirical antifungal therapy, while voriconazole failed to demonstrate noninferiority to LAmB. European guidelines recommend the use of either caspofungin or LAmB in this setting, while American guidelines do not suggest a preference. As noted, however, throughout this review, similar efficacy does not necessarily result in similar cost–effectiveness. In the current economic climate, new antifungal agents that come to market require not only a comparison of clinical efficacy, but also one of cost–effectiveness. Selection of the most appropriate empirical antifungal agents should not be purely by drug costs but also consider other factors, such as previous antifungal exposure, interactions with treatment for underlying disease and local epidemiology. The methods selected for cost–effectiveness comparisons require careful consideration. The inclusion of major cost drivers such as the cost of care for adverse outcomes and the cost of alternative treatment in the event of treatment failure should be made to allow better appreciation by the healthcare providers of the applicability of the findings to their own setting. To generalize findings to other settings is difficult given the differences in healthcare systems; however, to then reduce analyses to a simplistic approach is also not a true reflection of clinical practice. Thorough and consistent methodology is required to enable attempts to address the issue of external validity. Simplistic analyses of minimal cost categories and treatment pathways do not easily allow for this to occur.
Further research will be required to compare the clinical efficacy and pharmacoeconomics of the different antifungal treatment strategies and not just individual comparator drugs within the individual strategies. This means that future research may be focused, for example, towards a comparison of one agent used in empiric therapy compared with the same agent in pre-emptive therapy or in combination with other antifungals.
Expert Commentary
Caspofungin and LAmB have displayed similar efficacy in empirical antifungal therapy, while voriconazole failed to demonstrate noninferiority to LAmB. European guidelines recommend the use of either caspofungin or LAmB in this setting, while American guidelines do not suggest a preference. As noted, however, throughout this review, similar efficacy does not necessarily result in similar cost–effectiveness. In the current economic climate, new antifungal agents that come to market require not only a comparison of clinical efficacy, but also one of cost–effectiveness. Selection of the most appropriate empirical antifungal agents should not be purely by drug costs but also consider other factors, such as previous antifungal exposure, interactions with treatment for underlying disease and local epidemiology. The methods selected for cost–effectiveness comparisons require careful consideration. The inclusion of major cost drivers such as the cost of care for adverse outcomes and the cost of alternative treatment in the event of treatment failure should be made to allow better appreciation by the healthcare providers of the applicability of the findings to their own setting. To generalize findings to other settings is difficult given the differences in healthcare systems; however, to then reduce analyses to a simplistic approach is also not a true reflection of clinical practice. Thorough and consistent methodology is required to enable attempts to address the issue of external validity. Simplistic analyses of minimal cost categories and treatment pathways do not easily allow for this to occur.
Further research will be required to compare the clinical efficacy and pharmacoeconomics of the different antifungal treatment strategies and not just individual comparator drugs within the individual strategies. This means that future research may be focused, for example, towards a comparison of one agent used in empiric therapy compared with the same agent in pre-emptive therapy or in combination with other antifungals.
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