Low Dose Liposomal Amphotericin B (L-AmB) as Prophylaxis of Invasive Fungal Infections (IFI) in Neutropenic Patients (pts): Is It Cost Effective?.

Background In a recently reported randomized trial (ASH meeting 2005, oral presentation #1310) low-dose intravenous L-AmB reduced the incidence of IFI (20.2% vs. 4.6%, p<0.001) in high risk pts with hematological malignancies and prolonged neutropenia. The purpose of the current study was to compare the pharmacoeconomics of L-AmB prophylaxis vs. no systemic antifungal prophylaxis.

Methods: Records of all randomized pts with acute leukemia were reviewed for dosage and duration of antimycotic and antibiotic treatment during hospital stay. Based on this data and current drug prices the mean costs of antimicrobial treatment (AT) per hospital stay were calculated.

Results Pt. characteristics: Randomized pts 132; eligible pts 100; arm A: 56 (L-AmB prophylaxis); arm B: 44 (no prophylaxis). Baseline characteristics were balanced for age (mean 55.8 years), underlying disease (81 AML, 19 ALL) and duration of neutropenia (mean 18.5 days). Endpoints: The costs for antifungal treatment (excluding prophylaxis) were 360 Euro in arm A vs. 2170 Euro in arm B (p<0.001). Expenditures for antifungal prophylaxis accounted for 630 Euro in arm A vs. 0 Euro in arm B. The costs of antibiotic treatment were lower in arm A compared to arm B (210 Euro vs. 670 Euro, p<0.001). The total costs for AT (including antifungal prophylaxis) per hospital stay were 1200 Euro in arm A vs. 2840 Euro in arm B (p=0.071).

Conclusion: Our results suggest that antifungal prophylaxis with low dose L-AmB in high risk patients with hematologic malignancies has the potential to reduce the incidence of IFI and may be a cost-saving strategy.