Analysis of the efficiency and costs of antifungal prophylaxis and mycological diagnostics in patients undergoing allogeneic haematopoietic cell transplantation: “real life” evaluation

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• 作者：Hartmut Bertz ; Kathrin Drognitz ; Jürgen Finke
• 关键词：Antifungal prophylaxis and therapy ; Allogeneic HCT ; Cost analysis
• 刊名：Annals of Hematology
• 出版年：2016
• 出版时间：February 2016
• 年：2016
• 卷：95
• 期：3
• 页码：457-463
• 全文大小：277 KB
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• 作者单位：Hartmut Bertz (1)
  Kathrin Drognitz (1)
  Jürgen Finke (1)
  
  1. Department of Haematology/Oncology/Stem Cell Transplantation, University Medical Center Freiburg, Hugstetter Street 55, 79106, Freiburg, Germany
  
• 刊物类别：Medicine
• 刊物主题：Medicine & Public Health
  Hematology
  Oncology
  
• 出版者：Springer Berlin / Heidelberg
• ISSN：1432-0584

文摘

Antifungal prophylaxis/therapy (AP/AT) raises the cost of allogeneic haematopoietic cell transplantation (alloHCT). Its efficacy, different approaches for AP/AT, diagnostic measures and cost-effectiveness must still be evaluated. In 2010, we conducted a prospective study with 106 consecutive patients receiving an alloHCT analysing AP/AT, choice and costs of diagnostics applied including CT scans, galactomannan (Gal) and β-d-glucan (β-d) testing. Antifungal prophylaxis in 91 patients consisted of fluconazole (FLU) or L-AMB (AmBisome™ 1 or 3 mg/kg/day b.w.), and antifungal therapy had to be initiated in 38 % of the FLU/L-AMB-1-mg patients but in none with L-AMB 3 mg. Empirical AT consisted of L-AMB 1 mg/kg (n = 12) and preemptive AT of L-AMB 3 mg/kg (n = 17) and proved very efficacious with no further antifungal drug escalation in 89.6 %. Mean costs of diagnostic measures were 402 €/alloHCT; however, only 22 % of the CT scans, 4 % of β-d and 3 % of galactomannan testing were positive. We detected one proven, 17 probable and 14 possible fungal infections. Due to the German diagnosis-related group system with additional compensation, all our AP/AT strategies were adequately reimbursed. While clinical symptoms and CT scans are the most commonly used, inexpensive decision-making tools for starting AT, the expensive laboratory diagnostic procedures are ineffective; we have therefore discontinued regular GAL/β-d testing and changed our AP in patients at risk. Keywords Antifungal prophylaxis and therapy Allogeneic HCT Cost analysis