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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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Autores principales: Khoo, Ai Leng, Zhao, Ying Jiao, Tan, Glorijoy Shi En, Teng, Monica, Yap, Jenny, Tambyah, Paul Anantharajah, Ng, Chin Hin, Lim, Boon Peng, Chai, Louis Yi Ann
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8227639/
https://www.ncbi.nlm.nih.gov/pubmed/34073588
http://dx.doi.org/10.3390/jof7060417
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author Khoo, Ai Leng
Zhao, Ying Jiao
Tan, Glorijoy Shi En
Teng, Monica
Yap, Jenny
Tambyah, Paul Anantharajah
Ng, Chin Hin
Lim, Boon Peng
Chai, Louis Yi Ann
author_facet Khoo, Ai Leng
Zhao, Ying Jiao
Tan, Glorijoy Shi En
Teng, Monica
Yap, Jenny
Tambyah, Paul Anantharajah
Ng, Chin Hin
Lim, Boon Peng
Chai, Louis Yi Ann
author_sort Khoo, Ai Leng
collection PubMed
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.
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spelling pubmed-82276392021-06-26 Cost-Effectiveness of Serum Galactomannan Surveillance during Mould-Active Antifungal Prophylaxis Khoo, Ai Leng Zhao, Ying Jiao Tan, Glorijoy Shi En Teng, Monica Yap, Jenny Tambyah, Paul Anantharajah Ng, Chin Hin Lim, Boon Peng Chai, Louis Yi Ann J Fungi (Basel) Article 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. MDPI 2021-05-26 /pmc/articles/PMC8227639/ /pubmed/34073588 http://dx.doi.org/10.3390/jof7060417 Text en © 2021 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Khoo, Ai Leng
Zhao, Ying Jiao
Tan, Glorijoy Shi En
Teng, Monica
Yap, Jenny
Tambyah, Paul Anantharajah
Ng, Chin Hin
Lim, Boon Peng
Chai, Louis Yi Ann
Cost-Effectiveness of Serum Galactomannan Surveillance during Mould-Active Antifungal Prophylaxis
title 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_short Cost-Effectiveness of Serum Galactomannan Surveillance during Mould-Active Antifungal Prophylaxis
title_sort cost-effectiveness of serum galactomannan surveillance during mould-active antifungal prophylaxis
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8227639/
https://www.ncbi.nlm.nih.gov/pubmed/34073588
http://dx.doi.org/10.3390/jof7060417
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