Real-world financial and clinical impact of diagnostic-driven and empirical-treatment strategies in high-risk immunocompromised patients with suspected Aspergillus infection in the United Kingdom

Earnshaw, Stephanie R., McDade, Cheryl, Bryan, Andrew, Ines, Monica, Micallef, Christianne ORCID: https://orcid.org/0000-0002-4513-8199, Sung, Anita and Enoch, David A. (2022) Real-world financial and clinical impact of diagnostic-driven and empirical-treatment strategies in high-risk immunocompromised patients with suspected Aspergillus infection in the United Kingdom. Microbiology Spectrum, 10 (3). ISSN 2165-0497

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Abstract

A diagnostic-driven (DD) treatment strategy has proven successful for treating invasive fungal infections (IFIs) caused by Aspergillus. However, uptake of this treatment strategy is not fully embraced. This study compares the economic and clinical impact of DD and empirical-treatment (ET) strategies used within hospitals. Methods: a decision-analytic model was developed to compare costs and clinical outcomes associated with ET or a DD strategy of identifying infections caused by Aspergillus via galactomannan-antigen testing or Aspergillus polymerase chain reaction (PCR) in neutropenic patients with unexplained fever. Patients were treated prophylactically with antifungal treatments as seen in United Kingdom (UK) hospitals. The IFI incidence, response, mortality, resource use, and adverse events were obtained from meta-analyses and other clinical studies. Analyses were performed from the U.K. hospital perspective, and costs were obtained from standard costing sources. Although diagnostic-testing costs increased, total cost and length of stay were reduced by £1,121 and 1.54 days when treating via a DD strategy. Intensive care and general ward days accounted for . 40% of total costs and . 58% of the cost reduction came from reduced antifungal costs. Treating with a DD strategy reduced the number of patients being treated with antifungal agents while survival was increased. Thus, a DD strategy was cost savings (-£136,787 cost per death avoided) compared with an ET strategy. Conclusion: this study suggests that incorporating a DD strategy as the preferred treatment protocol may be a cost-saving and clinically improved treatment strategy for managing neutropenic patients with unexplained fever. IMPORTANCE Patients at risk of invasive fungal infections (IFIs), such as Aspergillus spp., tend to be immunocompromised and usually take several medications which may generate many side effects. Prescribing is further complicated by comorbidities, drug interactions and challenges accessing diagnostics. Therefore, adding another agent may be neither straightforward nor the best option for these types of patients. A diagnostic-driven (DD) treatment strategy has proven successful for treating IFIs. However, uptake of this treatment strategy is not fully embraced in clinical practice perhaps because this strategy is thought to be more costly and/or to result in higher mortality relative to treating empirically. We developed a decision-analytic model to examine the impact of these 2 strategies on costs and health outcomes. This study indicates that incorporating a DD strategy as the preferred treatment protocol may be a cost-saving and clinically improved treatment strategy for managing neutropenic patients with unexplained fever.

Item Type: Article
Uncontrolled Keywords: antifungal,aspergillosis,cost-effectiveness,economic evaluation,healthcare costs,invasive fungal infection,physiology,ecology,immunology and microbiology(all),genetics,microbiology (medical),cell biology,infectious diseases,sdg 3 - good health and well-being ,/dk/atira/pure/subjectarea/asjc/1300/1314
Faculty \ School: Faculty of Science > School of Pharmacy
Related URLs:
Depositing User: LivePure Connector
Date Deposited: 18 Aug 2022 09:30
Last Modified: 24 Sep 2022 07:04
URI: https://ueaeprints.uea.ac.uk/id/eprint/87426
DOI: 10.1128/spectrum.00425-22

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