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Article

Cost-Effectiveness of Serum Galactomannan Surveillance during Mould-Active Antifungal Prophylaxis

1
Pharmacy and Therapeutics Office, Group Health Informatics, National Healthcare Group, Singapore 138543, Singapore
2
Department of Infectious Diseases, Tan Tock Seng Hospital, National Centre for Infectious Diseases, Singapore 308442, Singapore
3
Division of Infectious Diseases, University Medicine Cluster, National University Health System, Singapore 117549, Singapore
4
Department of Pharmacy, National University Health System, Singapore 117549, Singapore
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Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117572, Singapore
6
Infectious Diseases Translational Research Programme, Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117572, Singapore
7
National University Cancer Institute, National University Health System, Singapore 117549, Singapore
*
Author to whom correspondence should be addressed.
Academic Editor: David S. Perlin
J. Fungi 2021, 7(6), 417; https://doi.org/10.3390/jof7060417
Received: 12 April 2021 / Revised: 14 May 2021 / Accepted: 19 May 2021 / Published: 26 May 2021
(This article belongs to the Special Issue Chemotherapy and Invasive Fungal Infection)
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. View Full-Text
Keywords: aspergillosis; biomarker; immunocompromised hosts; invasive fungal disease; pharmacoeconomics aspergillosis; biomarker; immunocompromised hosts; invasive fungal disease; pharmacoeconomics
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MDPI and ACS Style

Khoo, A.L.; Zhao, Y.J.; Tan, G.S.E.; Teng, M.; Yap, J.; Tambyah, P.A.; Ng, C.H.; Lim, B.P.; Chai, L.Y.A. Cost-Effectiveness of Serum Galactomannan Surveillance during Mould-Active Antifungal Prophylaxis. J. Fungi 2021, 7, 417. https://doi.org/10.3390/jof7060417

AMA Style

Khoo AL, Zhao YJ, Tan GSE, Teng M, Yap J, Tambyah PA, Ng CH, Lim BP, Chai LYA. Cost-Effectiveness of Serum Galactomannan Surveillance during Mould-Active Antifungal Prophylaxis. Journal of Fungi. 2021; 7(6):417. https://doi.org/10.3390/jof7060417

Chicago/Turabian Style

Khoo, Ai L., Ying J. Zhao, Glorijoy S.E. Tan, Monica Teng, Jenny Yap, Paul A. Tambyah, Chin H. Ng, Boon P. Lim, and Louis Y.A. Chai 2021. "Cost-Effectiveness of Serum Galactomannan Surveillance during Mould-Active Antifungal Prophylaxis" Journal of Fungi 7, no. 6: 417. https://doi.org/10.3390/jof7060417

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