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JOHN R. WINGARD, M.D., is Price Eminent Scholar and Professor of Medicine, Director, Blood and Marrow Transplant Program, and Deputy Director of the Gainesville Campus, Division of Hematology and Oncology, College of Medicine, University of Florida Shands Cancer Center, Gainesville. HELEN L. LEATHER, B.PHARM., BCPS, is Clinical Pharmacy Specialist, Bone Marrow Transplantation/Leukemia, Shands at the University of Florida, Gainesville. CRAIG A. WOOD, M.D., is Executive Scientific Director, Infectious Diseases; WILLIAM C. GERTH, M.B.A., is Senior Director, Outcomes Research; ROBERT J. LUPINACCI, M.S., is Biometrician; MARC L. BERGER, M.D., is Vice President, Outcomes Research; and EDWARD C. MANSLEY, PH.D., is Associate Director, Health Economics, Merck & Co., Inc., West Point, PA.

Address correspondence to Dr. Wingard at the Division of Hematology and Oncology, College of Medicine, University of Florida Shands Cancer Center, P.O. Box 100277, Gainesville, FL 32610-0277 (wingajr{at}medicine.ufl.edu).

Purpose. An analysis was conducted that evaluated and compared the cost differences between caspofungin and liposomal amphotericin B when the medications were used as empirical antifungal therapy for persistent fever during neutropenia. Methods. Rates of drug use and impaired renal function (IRF) were based on data from published studies. IRF was defined as a doubling of the serum creatinine level or, if the creatinine level was elevated at enrollment, an increase of at least 1 mg/dL. The estimates of the costs for drug acquisition and treating IRF were derived using published data and applied to compare caspofungin with liposomal amphotericin B. Sensitivity analyses were performed by varying the IRF and relative acquisition costs to assess the effect of these factors on the cost differences. Results. The acquisition costs per patient were $6942 for liposomal amphotericin B and $3996 for caspofungin. The estimated cost per patient from IRF was $3173 for liposomal amphotericin B and $793 for caspofungin. Combining drug acquisition and IRF costs, the overall treatment cost per patient for caspofungin was $5326 less than for liposomal amphotericin B. In sensitivity analyses of drug costs, the price of liposomal amphotericin B would have to be $23.95 per vial for the overall treatment costs to be equal. Conclusion. Comparison of cost estimates derived from published data revealed that a combined estimate of acquisition costs and costs related to the treatment of IRF was lower for caspofungin than for liposomal amphotericin B for empirically treating patients with neutropenic fever. Index terms: Amphotericin B; Antifungals; Caspofungin; Costs; Drug comparisons; Liposomes; Neutropenia; Pharmacoeconomics; Toxicity