Economic assessment of fidaxomicin for the treatment of Clostridium difficile infection (CDI) in special populations (patients with cancer, concomitant antibiotic treatment or renal impairment) in Spain.

The objective of this paper was to assess the cost-utility of fidaxomicin versus vancomycin in the treatment of Clostridium difficile infection (CDI) in three specific CDI patient subgroups: those with cancer, treated with concomitant antibiotic therapy or with renal impairment. A Markov model with six health states was developed to assess the cost-utility of fidaxomicin versus vancomycin in the patient subgroups over a period of 1 year from initial infection. Cost and outcome data used to parameterise the model were taken from Spanish sources and published literature. The costs were from the Spanish hospital perspective, in Euros (€) and for 2013. For CDI patients with cancer, fidaxomicin was dominant versus vancomycin [gain of 0.016 quality-adjusted life-years (QALYs) and savings of €2,397 per patient]. At a cost-effectiveness threshold of €30,000 per QALY gained, the probability that fidaxomicin was cost-effective was 96 %. For CDI patients treated with concomitant antibiotic therapy, fidaxomicin was the dominant treatment versus vancomycin (gain of 0.014 QALYs and savings of €1,452 per patient), with a probability that fidaxomicin was cost-effective of 94 %. For CDI patients with renal impairment, fidaxomicin was also dominant versus vancomycin (gain of 0.013 QALYs and savings of €1,432 per patient), with a probability that fidaxomicin was cost-effective of 96 %. Over a 1-year time horizon, when fidaxomicin is compared to vancomycin in CDI patients with cancer, treated with concomitant antibiotic therapy or with renal impairment, the use of fidaxomicin would be expected to result in increased QALYs for patients and reduced overall costs.

[Cost-effectiveness analysis of the empirical antifungal strategy in oncohaematological patients]. / Estudio coste-efectividad de la estrategia empírica antifúngica en pacientes oncohematológicos.

OBJECTIVE: Observational study performing a cost-effectiveness analysis of the empirical antifungal strategy in high-risk oncohaematological patients, from the hospital perspective and with an average time horizon of 10.8 days of treatment. METHOD: Data gathered: effectiveness, purchase costs and other costs (diagnostic tests, hospitalisation, and second-line antifungal therapy). A total of 107 patients were analysed, 115 invasive fungal infection sub-episodes and 138 empirical treatments. RESULTS: The effectiveness and average cost/treatment were: voriconazole 88% and 20,108.8 euro, caspofungin 68% and 49,067.7 euro, Amphotericin B Lipid Complex (ABLC) 58% and 30,375.2 euro, and Amphotericin B Liposome (AB-L) 50% and 38,234.5 euro. The first tree designed shows voriconazole as the dominant option, although there are few case studies. The second tree selects ABLC in comparison to AB-L and caspofungin, with an average CE of 52,371 euro, the nearest figure to the established availability to pay (50,000 euro). The sensitivity analysis evaluates the most influential parameters. The variation in the cost of purchasing do not modify the sense of the analysis, and the modification of 25% in other costs for caspofungin reverses the ratio, making this the most cost-effective option. The ICE indicates that using voriconazole instead of caspofungin saves 144,794 euro. With regard to caspofungin, ABLC increases the cost by 186,925 euro, a deceptive figure influenced by a level of effectiveness that is not very different; and AB-L increases the cost by 60,184 euro. CONCLUSIONS: The analysis provides relevant information from the perspective of clinical practice in spite of the limitations of the unconsidered costs (nephrotoxicity). This type of analysis contributes to rationalising the use of antifungal agents in the hospital setting and in high-risk patients such as oncohaematological ones.

[Daptomycin: revitalizing a former drug due to the need of new active agents against grampositive multiresistant bacterias]. / Daptomicina: revitalizando un antiguo fármaco ante la necesidad de nuevos agentes activos frente a bacterias grampositivas multirresistentes.

The development of mechanisms of resistance of many Gram-positive bacterial strains that cause complicated skin and soft tissue infections, as well as sepsis and bacteremia, has necessitated the search for new drugs that will improve treatment strategies. Daptomycin is a cyclic lipopeptide antibacterial that was launched for the treatment of complicated skin and soft tissue infections caused by Gram-positive organisms. The drug's mechanism of action is different from that of any other antibiotic. It binds to bacterial membranes and causes a rapid depolarization of membrane potential. This loss of membrane potential causes inhibition of protein, DNA and RNA synthesis, which results in bacterial cell death. The in vitro spectrum of activity of daptomycin encompasses most clinically relevant aerobic Gram-positive pathogenic bacteria. Compared to other antibiotics with a similar antibacterial spectrum, daptomycin does not cause nephrotoxicity. Taking these and other characteristics into consideration, daptomycin appears to be a good alternative to other drugs used in the treatment of complicated skin and soft tissue infections and in Gram-positive bacteremial infections.