Cost-Effectiveness of Serum Galactomannan Surveillance during Mould-Active Antifungal Prophylaxis
Serial galactomannan (GM) monitoring can aid the diagnosis of invasive aspergillosis (IA) and optimise treatment decisions. However, widespread adoption of mould-active prophylaxis has reduced the incidence of IA and challenged its use. We evaluated the cost-effectiveness of prophylaxis-biomarker st...
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doaj-ddfdef45a1ff40ae83842c80de46bda22021-06-01T01:14:06ZengMDPI AGJournal of Fungi2309-608X2021-05-01741741710.3390/jof7060417Cost-Effectiveness of Serum Galactomannan Surveillance during Mould-Active Antifungal ProphylaxisAi Leng Khoo0Ying Jiao Zhao1Glorijoy Shi En Tan2Monica Teng3Jenny Yap4Paul Anantharajah Tambyah5Chin Hin Ng6Boon Peng Lim7Louis Yi Ann Chai8Pharmacy and Therapeutics Office, Group Health Informatics, National Healthcare Group, Singapore 138543, SingaporePharmacy and Therapeutics Office, Group Health Informatics, National Healthcare Group, Singapore 138543, SingaporeDepartment of Infectious Diseases, Tan Tock Seng Hospital, National Centre for Infectious Diseases, Singapore 308442, SingaporePharmacy and Therapeutics Office, Group Health Informatics, National Healthcare Group, Singapore 138543, SingaporeDepartment of Pharmacy, National University Health System, Singapore 117549, SingaporeDivision of Infectious Diseases, University Medicine Cluster, National University Health System, Singapore 117549, SingaporeDepartment of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117572, SingaporePharmacy and Therapeutics Office, Group Health Informatics, National Healthcare Group, Singapore 138543, SingaporeDivision of Infectious Diseases, University Medicine Cluster, National University Health System, Singapore 117549, SingaporeSerial galactomannan (GM) monitoring can aid the diagnosis of invasive aspergillosis (IA) and optimise treatment decisions. However, widespread adoption of mould-active prophylaxis has reduced the incidence of IA and challenged its use. We evaluated the cost-effectiveness of prophylaxis-biomarker strategies. A Markov model simulating high-risk patients undergoing routine GM surveillance with mould-active versus non-mould-active prophylaxis was constructed. The incremental cost for each additional quality-adjusted life-year (QALY) gained over a lifetime horizon was calculated. In 40- and 60-year-old patients receiving mould-active prophylaxis coupled with routine GM surveillance, the total cost accrued was the lowest at SGD 11,227 (USD 8255) and SGD 9234 (USD 6790), respectively, along with higher QALYs gained (5.3272 and 1.1693). This strategy, being less costly and more effective, dominated mould-active prophylaxis with no GM monitoring or GM surveillance during non-mould-active prophylaxis. The prescription of empiric antifungal treatment was influential in the cost-effectiveness. When the GM test sensitivity was reduced from 80% to 30%, as might be anticipated with the use of mould-active prophylactic agents, the conclusion remained unchanged. The likelihood of GM surveillance with concurrent mould-active prophylaxis being cost-effective was 77%. Routine GM surveillance remained cost-effective during mould-active prophylaxis despite lower IA breakthroughs. Cost-saving from reduced empirical antifungal treatment was an important contributing factor.https://www.mdpi.com/2309-608X/7/6/417aspergillosisbiomarkerimmunocompromised hostsinvasive fungal diseasepharmacoeconomics |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Ai Leng Khoo Ying Jiao Zhao Glorijoy Shi En Tan Monica Teng Jenny Yap Paul Anantharajah Tambyah Chin Hin Ng Boon Peng Lim Louis Yi Ann Chai |
spellingShingle |
Ai Leng Khoo Ying Jiao Zhao Glorijoy Shi En Tan Monica Teng Jenny Yap Paul Anantharajah Tambyah Chin Hin Ng Boon Peng Lim Louis Yi Ann Chai Cost-Effectiveness of Serum Galactomannan Surveillance during Mould-Active Antifungal Prophylaxis Journal of Fungi aspergillosis biomarker immunocompromised hosts invasive fungal disease pharmacoeconomics |
author_facet |
Ai Leng Khoo Ying Jiao Zhao Glorijoy Shi En Tan Monica Teng Jenny Yap Paul Anantharajah Tambyah Chin Hin Ng Boon Peng Lim Louis Yi Ann Chai |
author_sort |
Ai Leng Khoo |
title |
Cost-Effectiveness of Serum Galactomannan Surveillance during Mould-Active Antifungal Prophylaxis |
title_short |
Cost-Effectiveness of Serum Galactomannan Surveillance during Mould-Active Antifungal Prophylaxis |
title_full |
Cost-Effectiveness of Serum Galactomannan Surveillance during Mould-Active Antifungal Prophylaxis |
title_fullStr |
Cost-Effectiveness of Serum Galactomannan Surveillance during Mould-Active Antifungal Prophylaxis |
title_full_unstemmed |
Cost-Effectiveness of Serum Galactomannan Surveillance during Mould-Active Antifungal Prophylaxis |
title_sort |
cost-effectiveness of serum galactomannan surveillance during mould-active antifungal prophylaxis |
publisher |
MDPI AG |
series |
Journal of Fungi |
issn |
2309-608X |
publishDate |
2021-05-01 |
description |
Serial galactomannan (GM) monitoring can aid the diagnosis of invasive aspergillosis (IA) and optimise treatment decisions. However, widespread adoption of mould-active prophylaxis has reduced the incidence of IA and challenged its use. We evaluated the cost-effectiveness of prophylaxis-biomarker strategies. A Markov model simulating high-risk patients undergoing routine GM surveillance with mould-active versus non-mould-active prophylaxis was constructed. The incremental cost for each additional quality-adjusted life-year (QALY) gained over a lifetime horizon was calculated. In 40- and 60-year-old patients receiving mould-active prophylaxis coupled with routine GM surveillance, the total cost accrued was the lowest at SGD 11,227 (USD 8255) and SGD 9234 (USD 6790), respectively, along with higher QALYs gained (5.3272 and 1.1693). This strategy, being less costly and more effective, dominated mould-active prophylaxis with no GM monitoring or GM surveillance during non-mould-active prophylaxis. The prescription of empiric antifungal treatment was influential in the cost-effectiveness. When the GM test sensitivity was reduced from 80% to 30%, as might be anticipated with the use of mould-active prophylactic agents, the conclusion remained unchanged. The likelihood of GM surveillance with concurrent mould-active prophylaxis being cost-effective was 77%. Routine GM surveillance remained cost-effective during mould-active prophylaxis despite lower IA breakthroughs. Cost-saving from reduced empirical antifungal treatment was an important contributing factor. |
topic |
aspergillosis biomarker immunocompromised hosts invasive fungal disease pharmacoeconomics |
url |
https://www.mdpi.com/2309-608X/7/6/417 |
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