| Invasive fungal infections, if contracted, can cause significant morbidity and mortality in recipients of hematopoietic stem cell transplants. Because of the associated morbidity and mortality, prophylactic interventions have been employed to prevent or minimize the risk of invasive fungal infections. Besides fluconazole, which has been the standard of care, newer pharmaceutical agents have become available. The newer antifungal agents are more expensive with greater toxicity than fluconazole. However, the newer antifungal agents provide better protection against mold IFIs which are associated with higher mortality and treatment costs compared to other types of IFI. Minimal research has been conducted on the incremental cost effectiveness of the various pharmaceutical treatment options.;The purpose of this study was to conduct an economic evaluation of pharmaceutical agents used for prophylactic antifungal therapy in hematopoietic stem cell transplant recipients in the immediate post-transplant time period. Specifically, the aim of this research was to estimate the cost effectiveness of antifungal prophylaxis of two newer antifungal agents, itraconazole and voriconazole, compared to fluconazole for the prevention of invasive fungal infections. A decision-analytic Markov model was developed to compare the clinical benefits and costs associated with clinical strategies of antifungal prophylaxis. The base case analysis was conducted consistent with the Panel Recommendations for a Reference Case. The analysis was conducted from the societal perspective and the results are reported in terms of US dollars per quality-adjusted life years and dollars per life year gained. Sensitivity analyses were conducted to evaluate for error and uncertainty in the model.;Itraconazole was found to be the cost effective option at a willingness to pay threshold of ;Recommendations for future research include additional studies on the efficacy of prophylactic antifungal therapies, particularly new medications that are being used clinically and recommended in guidelines without strong efficacy data in this patient population.;Cost effectiveness analysis has emerged as a valuable methodology for nursing research. It is essential that nurses, key decision makers who influence health policy, understand cost effectiveness research and incorporate the methodology into studies. |
