OBJECTIVES: To examine the clinical and economic impact of diagnostic-driven (DD) versus empiric treatment strategies in neutropenic patients with suspected Aspergillus invasive fungal infections (IFIs) in Beijing, Chengdu, and Guangzhou, China.
METHODS: A decision-analytic model was used to estimate total costs and survival associated with a DD and empiric treatment strategy for managing suspected IFIs in adult patients with neutropenia due to hematological malignancy or autologous/allogeneic stem cell transplant. In the DD strategy, IFI was identified via serum galactomannan (GM) enzyme-linked immunosorbent assay (ELISA) so that early initiation of targeted treatment could be administered. IFI incidence (10.9%), portion of actual IFIs diagnosed via empiric treatment (30%), overall mortality (10.7%), and IFI-related mortality (28.6%) were obtained from the literature. Survival rates were generated based on the proportion of patients with identified and appropriately treated IFIs. Empiric and DD treatment patterns and resource use were based on clinical opinion (3-5 clinicians from top hospitals per city). Medical costs (in 2014 Chinese Yuan [¥]) included antifungal drugs, treatment-related adverse events, and other medical resource costs. City-specific costing sources were used wherever possible.
RESULTS: Medical costs were lower for the DD versus the empiric strategy in Beijing (¥4,118 vs ¥5,245), Chengdu, (¥5,463 vs ¥6,389), and Guangzhou (¥9,762 vs ¥10,351). Fewer patients received antifungal treatment using the DD strategy (6.7% versus 11.4%), and survival rates were similar. One-way sensitivity analysis showed results were most sensitive to changes in GM test sensitivity followed by IFI incidence. Probabilistic sensitivity analysis showed that treating via a DD strategy was dominant 99% of the time.
CONCLUSIONS: These results suggest that in China, a DD strategy to identify IFIs in immunocompromised patients with persistent fever in order to better target antifungal treatment compared to an empiric antifungal treatment strategy may be cost-saving, while maintaining a similar overall survival rate.
