Important note: Information in this article was accurate in 1997. The state of the art may have changed since the publication date.
Liposomal amphotericin B in the treatment of invasive fungal infections.
Bristol, England : U.K. National Health Service, South and West Regional Health Authority, 1995. 12 p. (Development and evaluation committee report ; no. 37) Unique Identifier : AIDSLINE MED/97620731 Bliss E; Directorate (U.K.); Canynge Hall, Whiteladies Road, Bristol BS8 2PR, England.; http://www.epi.bris.ac.uk/rd/publicat/dec/dec37.htm).
Abstract:
(1) Invasive fungal infection arises from immunocompromisation associated usually with cancer or leukaemia or immuno-suppressive therapy perhaps in the context of transplantation, or AIDS. (2) Sufficiently high doses of conventional amphotericin B are often not possible for reasons of toxicity and renal impairment. (3) Liposomal amphotericin B ('AmBisome') has been shown to be much better tolerated than conventional Amphotericin. Much higher doses can be given with fewer toxic reactions. However, AmBisome is expensive, costing 145 British pounds sterling per 50 mg. (4) Definitive diagnosis is notoriously difficult to make because the symptoms of invasive fungal infection are so vague. Therefore, systemic anti-fungal treatment is usually started defensively, early. Therefore inevitably there will be some over-treatment, and this should be borne in mind when cost-benefit analyses are undertaken. Clearly tight protocols are necessary and some over-prescription will need to be expected. (5) There have been no randomised controlled trials of liposomal amphotericin to date, and all but one of the comparative studies that have been done have been unblinded. The total additional costs of using this agent for 100 patients is about 825,000 British pounds sterling and this cost might buy approximately 290 life-years. This means that the cost per additional life-year is approximately 2,850 British pounds sterling. (6) A new lipid-associated drug ('Abelcet') has now entered the market. Technically Abelcet is not a liposomal amphotericin but it does have the same indications. It is said that there are good trial data to support its use under the same conditions as liposomal amphotericin. Additionally, it may be even less toxic than liposomal amphotericin. The new agent treatment costs are less than half the costs of liposomal amphotericin. CONCLUSION OF DEVELOPMENT AND EVALUATION COMMITTEE. Recommended. The Committee suggested that note should be taken of the following: (1) Liposomal amphotericin B should only be used after standard amphotericin has been tried and shown to produce toxicity; (2) The cost-utility of this treatment is likely to change in the near future as costs of the drug will fall.
Keywords: *Amphotericin B/ADMINISTRATION & DOSAGE *Amphotericin B/ADVERSE EFFECTS *Amphotericin B/ECONOMICS *Antibiotics, Antifungal/ADMINISTRATION & DOSAGE *Antibiotics, Antifungal/ADVERSE EFFECTS *Antibiotics, Antifungal/ECONOMICS *Mycoses/DRUG THERAPY 971130
M97B1220
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Important note: Information in this article was accurate in 1997. The state of the art may have changed since the publication date.
