CURRENT I SS UES

Determine the cost effectiveness of prophylactic fluconazole

A well-designed cost analysis is needed to determine the cost effectiveness of prophylactic fluconazole in the treatment of fungal infections in patients with antineoplastic-induced neutropenia. according to Drs Sandra Preston and Laurie Briceland from the Albany College of Pharmacy. New York. US.

Fluconazole 50 mg/day, ketoconazolc 400 mg/day and c1otrimazole lOmg.3-5 times daily are comparable in terms of acquisition cost. However. fluconazole 400 mg/day, the most commonly used dose for the treatment of patients with neutropenia, is significantly more expensive.

High-dose fluconazole could have a considerable impact on healthcare costs, particu larly in a hospital where a large number of patients with leukaemia are undergoing bone marrow transplantation. say Drs Preston and Briceland. Also, using amphotericin B for the treatment of fluconazole-resistant organisms may increase costs due to increased monilOring and duration of hospitali sation, and additional drug therapy. However, these costs would be avoided if high-dose fluconazole was shown to decrease the

incidence of infectious complications. note Drs Preston and Briceland. They claim that. in this situation. fluconazole 400 mg/day would be cost effective. Presum SL. Briccland u.. fluo;onazok for anuIi.mpl p-opby1ui$ in cbaDolherapy·induocd DeIJ~ AmericaD JouraaI of Health-Sys&em I'Iw'mKy 52: 164. 17). 15 Jan 1995 _,

News in brief ...

• Guidelines compiled in coll aboration with the appropriate specialists, and aJlowing for limited resources, can maximise the optimaJ use of new and expensive medicines, suggest investigators from Auckland Hospital. New Zealand. The hospital uses a fonn wary system that requires completion of a question­naire and approval by the medicines JXllicy committee before a new medicine is added. Before approval , the medicine must be shown to have a clear advantage, either in terms of efficacy or cost, over CUJTeOt formulary agents. 1be medicines JXllicy committee aJso produces guidelines for the use of approved agents; these guide­lines are designed in consultation with spcciaJists using the agent. Goo K, e\ aI. Guidelines for the use of upensivt: mc:di<:ines. New ZuI&nd Medical JoumaII08: 3&-40. 8 Feb 1995 __

International Research and Opinion

Enoxaparin a good choice for patients with nephrotic syndrome

The low-molecular weight heparin enoxaparin is effective as a prophylactic anticoagulant and well accepted by patients with nephrotic syndrome. say French researchers. Furthermore, such preventive treatment may yield a net monetary benefit over no treatment.

No cases of thrombosis developed among 65 patients with nephrotic syndrome who were treated with enoxaparin 20-40 mg/day for 1-48 months in the French study.

Assumptions used in cost·benefit analysis

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A cost-benefit analysis estimated that costs averted by anticoagulant treatment over I year for I patient (e.g. by the avoidance of chronic renal vein thrombosis or pulmonary embolism) amounted to SUS3885. while the costs of treatment., including drug and disJXlsable costs and follow· up tests, amounted to SUS4022. Thus. the hea1thcare system would carry a cost of

sus 137 to prevent thrombotic complications in I patient with nephrotic syndrome over a I-year period.

However, sensitivity analysis revealed that costs were highly sensitive to changes in the estimates of the incidence of complications and efficacy of enoxaparin (see tabl4 For the 'worst-benefit' case. it was estimated that it would cost the health care system SUS2 195 to treat I patient for 1 year, while a net benefit of SUS 1648 was calculated for the 'best-benefit ' case.

The cost-benefit analysis did not consider the costs of adverse effects of treatment, or benefits in terms of well-being or the prevention of mortality. RoscokerQ, DInnd·Zalc~ I. Petit-PbarM, Mudi AB. J_1i N. ct al. Prevention of thrombotic complications of the r.ephrotic syndrome by the looo-mokcuw-weiaJu heparin eooupllrin. Nephron 69: 20-28. Jan I99S - ,. Cost considerations ...

• Allergy evaluations for patients with asthma are cost saving and improve the quality of care, according to investigators from a health maintenance organisation in Denver, Colorado, US. Their retrospective review of asthma management for 70 patients showed that hospitalisations decreased by 68% in the year after allergy evaluation and avernge hospital stay decreased from 4 to 2.5 days. Also, the nwnber of office visits feU by 46% and urgent care visits decreased by 56% after allergy evaluation. Cost savings were estimated to be SU5145500. westle, CR, d al.. A1IaJy rdtnalkost dfeclivt: __ 1994 Amlual McetiD.a _ Amo::rican ColIcJC of A1IaJy and 1rnmuDoIotY : 5. 1994 [SummarUed fn:m aD abItrxt] _ .. u

PHARMACOAESOURCES 25 Fetl 11M

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