Bryan A, Earnshaw SR, McDade C, Ines M, Micallef C, Enoch DA. Economic evaluation of diagnostic-driven versus empirical treatment strategies in high-risk immunocompromised patients with suspected Aspergillus infection. Poster presented at the 2021 Virtual 31st European Congress of Clinical Microbiology and Infectious Diseases (ECCMID); July 9, 2021.

BACKGROUND: A diagnostic-driven (DD) treatment strategy has proven successful for treating invasive fungal infections (IFIs) caused by Aspergillus. In addition, more treatment options have become available for these patients. However, uptake of this treatment strategy is still not fully embraced. This study compares the economic and clinical impact of DD and empirical treatment (ET) strategies used within a hospital.

MATERIALS: A novel decision-analytic model was developed to compare costs and clinical outcomes associated with ET (liposomal amphotericin B or caspofungin) or a DD strategy of identifying infections caused by Aspergillus via GM antigen testing or Aspergillus PCR testing with early initiation of targeted treatments (isavuconazole, voriconazole, or liposomal amphotericin B) in neutropenic patients with unexplained fever. Patients were adults aged ≥18 years with haematological malignancies or autologous/allogeneic stem cell transplantation expected to be neutropenic for ≥10 days. Antifungal prophylaxis with posaconazole impacted costs as well as incidence of IFIs. Patients were assumed to be treated with a mix of antifungal treatments as seen in United Kingdom (UK) hospitals. IFI incidence, response, mortality, and adverse events were obtained from meta-analyses and other published clinical studies. Nonresponding patients were treated with second-line antifungal agents. Duration of treatment, length of stay in the hospital, and other resource use were obtained from published literature and verified by expert clinicians. Analyses were performed from the UK hospital perspective, and costs were obtained from standard UK costing sources.

RESULTS: Although increased costs occur due to diagnostic testing, total cost and length of stay were reduced by £1,331 and 1.47 days when treating via a DD strategy rather than an ET strategy with intensive care and general ward days accounting for >45% of the total costs and >75% of the cost reduction coming from reduced antifungal costs. Treating with a DD approach also reduced the number of patients being treated with antifungal agents (33 versus 57 per 1000) while survival was increased (90.3% versus 83.7%).

CONCLUSION: This study suggests that incorporating DD approach as the preferred treatment protocol may be a cost saving and clinically improved treatment strategy for managing neutropenic patients with unexplained fever.

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