Letter to the Editor
Long-term cost-effectiveness of lipid formulations of amphotericin B in the empirical therapy of invasive mycosis in a developing country
Rentabilidad a largo plazo de las formulaciones lipídicas de anfotericina B en la terapia empírica de micosis invasivas en un país en desarrollo
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Florinda" "apellidos" => "San Juan-Delgado" ] 2 => array:2 [ "nombre" => "Julio" "apellidos" => "García-Rodríguez" ] ] ] ] ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1130140617300347?idApp=UINPBA00004N" "url" => "/11301406/0000003400000004/v1_201711120057/S1130140617300347/v1_201711120057/es/main.assets" ] "en" => array:16 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Editor</span>" "titulo" => "Long-term cost-effectiveness of lipid formulations of amphotericin B in the empirical therapy of invasive mycosis in a developing country" "tieneTextoCompleto" => true "saludo" => "Dear Editor," "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "247" "paginaFinal" => "248" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Felipe Francisco Tuon, Khaiany Lino Florencio, Jaime L. Rocha, Francisco Beraldi Magalhaes" "autores" => array:4 [ 0 => array:4 [ "nombre" => "Felipe Francisco" "apellidos" => "Tuon" "email" => array:1 [ 0 => "tuon@ufpr.br" ] "referencia" => array:3 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] 2 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Khaiany Lino" "apellidos" => "Florencio" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "Jaime L." "apellidos" => "Rocha" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 3 => array:3 [ "nombre" => "Francisco Beraldi" "apellidos" => "Magalhaes" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Department of Medicine, School of Health and Biosciences, Pontifícia Universidade Católica do Paraná, Curitiba, PR, Brazil" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Division of Infectious Diseases, Hospital de Clínicas da Universidade Federal do Paraná, Curitiba, PR, Brazil" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Rentabilidad a largo plazo de las formulaciones lipídicas de anfotericina B en la terapia empírica de micosis invasivas en un país en desarrollo" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1625 "Ancho" => 2568 "Tamanyo" => 127359 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Break-even value of ABLC to be cost-effective in comparison with d-AMB.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Clinical use of lipid formulations of amphotericin B is markedly limited by acquisition costs in developing countries.<a class="elsevierStyleCrossRefs" href="#bib0070"><span class="elsevierStyleSup">6,7</span></a> The aim of this study is to assemble a model of cost-effectiveness of amphotericin B lipid complex (ABLC) in patients with invasive mycoses in a public Brazilian hospital. This is a pharmacoeconomic analysis from the payers’ perspective based on a retrospective observational study published previously about the incidence of acute kidney injury (AKI) in patients using deoxycholate amphotericin B (d-AMB).<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">8</span></a> One hundred and six adult patients were included. The incidence of AKI with ABLC was estimated through another cohort,<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">1</span></a> and in-hospital mortality rate was used as primary endpoint. In the model, the outcome of patients who received ABLC was considered similar to that of patients who received d-AMB, according to a previous publication<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">5</span></a> (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). The probability of evolving to chronic hemodialysis (HD) after developing AKI that required acute HD was estimated according to a previous study of Duran et al.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">2</span></a> Finally, in order to predict the 10 years outcome of every patient under chronic HD after discharge we used reported data from the publication of Gomez et al.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">3</span></a> In Brazil, patients under chronic HD are retired, and the retirement pension fee is the 80% of the mean salary of the last five years (US$ 302.34; minimum salary of the Parana State in Brazil).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">Sensitivity analysis was performed considering ±25% of used costs.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">4</span></a> Only the direct cost of amphotericin B (updated to December 2016) was included, (ABLC<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>US$ 360.53/50<span class="elsevierStyleHsp" style=""></span>mg d-AMB<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>US$ 36.61/50<span class="elsevierStyleHsp" style=""></span>mg). Costs of chronic HD values were considered those paid by Brazilian public health system to public hemodialysis clinics per HD session (US$ 74.76).</p><p id="par0015" class="elsevierStylePara elsevierViewall">From 106 patients, five were submitted to acute HD due to acute renal failure attributed to treatment with d-AMB (4.72%). Global in-hospital mortality rate was 46%. It may be inferred that 2.17% of the patients were discharged from hospital after acute HD. Considering the previous study of Duran et al.,<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">2</span></a> we estimated that 0.8% of these patients treated with d-AMB would be under chronic HD. Considering 106 patients, the total cost of d-AMB, chronic HD and retirement would be US$ 54,343.66, US$ 27,000.35, and US$ 98,331.33, respectively. On the other hand, if the same group would have received ABLC, total cost of ABLC, chronic HD and retirement would be US$ 1,605,228.17, US$ 10,125.13, and US$ 36,874.25, respectively. The break-even value of ABLC to be cost-effective in comparison with d-AMB is US$ 67.61, a value very different from the current value of US$ 360.56 per vial (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>).</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">Despite the high cost of chronic HD and retirement, direct cost of lipid formulations in Brazil is too high to be considered cost-effective. However, a subset of patients with early renal dysfunction should be re-analyzed in the future because ABLC induces less renal injury and consequently fewer patients would be on chronic HD. This aspect is important for a future re-evaluation of the cost of these patients not to be included in the model as well as costs beyond 10 years of life.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicts of interest</span><p id="par0025" class="elsevierStylePara elsevierViewall">This study was supported by TEVA, that had no influence at all on the content of the paper. Felipe Tuon receives grants from TEVA and is a CNPQ researcher.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Conflicts of interest" ] 1 => array:2 [ "identificador" => "xack317091" "titulo" => "Acknowledgements" ] 2 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "multimedia" => array:2 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 2417 "Ancho" => 3148 "Tamanyo" => 302931 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Tree decision of ABLC to be cost-effective in comparison with d-AMB.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1625 "Ancho" => 2568 "Tamanyo" => 127359 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Break-even value of ABLC to be cost-effective in comparison with d-AMB.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:8 [ 0 => array:3 [ "identificador" => "bib0045" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Study of renal safety in amphotericin B lipid complex-treated patients" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "B.D. 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Rocha" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.riam.2012.09.003" "Revista" => array:6 [ "tituloSerie" => "Rev Iberoam Micol" "fecha" => "2013" "volumen" => "30" "paginaInicial" => "21" "paginaFinal" => "24" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22995903" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] "agradecimientos" => array:1 [ 0 => array:4 [ "identificador" => "xack317091" "titulo" => "Acknowledgements" "texto" => "<p id="par0030" class="elsevierStylePara elsevierViewall">We thank Clea Ribeiro and Group of the Service of Epidemiology of the Hospital de Clínicas da UFPR.</p>" "vista" => "all" ] ] ] "idiomaDefecto" => "en" "url" => "/11301406/0000003400000004/v1_201711120057/S1130140617300591/v1_201711120057/en/main.assets" "Apartado" => array:4 [ "identificador" => "8081" "tipo" => "SECCION" "es" => array:2 [ "titulo" => "Carta a los Directores" "idiomaDefecto" => true ] "idiomaDefecto" => "es" ] "PDF" => "https://static.elsevier.es/multimedia/11301406/0000003400000004/v1_201711120057/S1130140617300591/v1_201711120057/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1130140617300591?idApp=UINPBA00004N" ]
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| 2021 October | 21 | 13 | 34 |
| 2021 September | 11 | 10 | 21 |
| 2021 August | 36 | 8 | 44 |
| 2021 July | 16 | 15 | 31 |
| 2021 June | 18 | 12 | 30 |
| 2021 May | 12 | 13 | 25 |
| 2021 April | 36 | 23 | 59 |
| 2021 March | 34 | 10 | 44 |
| 2021 February | 9 | 9 | 18 |
| 2021 January | 12 | 15 | 27 |
| 2020 December | 20 | 14 | 34 |
| 2020 November | 15 | 10 | 25 |
| 2020 October | 16 | 4 | 20 |
| 2020 September | 15 | 13 | 28 |
| 2020 August | 18 | 7 | 25 |
| 2020 July | 15 | 5 | 20 |
| 2020 June | 18 | 13 | 31 |
| 2020 May | 12 | 8 | 20 |
| 2020 April | 20 | 4 | 24 |
| 2020 March | 20 | 7 | 27 |
| 2020 February | 19 | 3 | 22 |
| 2020 January | 15 | 8 | 23 |
| 2019 December | 16 | 9 | 25 |
| 2019 November | 28 | 6 | 34 |
| 2019 October | 18 | 9 | 27 |
| 2019 September | 13 | 5 | 18 |
| 2019 August | 12 | 3 | 15 |
| 2019 July | 11 | 13 | 24 |
| 2019 June | 17 | 3 | 20 |
| 2019 May | 62 | 50 | 112 |
| 2019 April | 26 | 11 | 37 |
| 2019 March | 10 | 4 | 14 |
| 2019 February | 5 | 4 | 9 |
| 2019 January | 7 | 2 | 9 |
| 2018 December | 3 | 2 | 5 |
| 2018 November | 5 | 4 | 9 |
| 2018 October | 6 | 9 | 15 |
| 2018 September | 5 | 4 | 9 |
| 2018 August | 4 | 4 | 8 |
| 2018 July | 3 | 2 | 5 |
| 2018 June | 3 | 1 | 4 |
| 2018 May | 7 | 4 | 11 |
| 2018 April | 1 | 4 | 5 |
| 2018 March | 3 | 2 | 5 |
| 2018 February | 3 | 0 | 3 |
| 2018 January | 15 | 3 | 18 |
| 2017 December | 1 | 0 | 1 |
| 2017 November | 3 | 0 | 3 |
Show all
