| Description |
Bone marrow transplantation (BMT) is a medical procedure offered to selected patients with nonmalignant and malignant diseases. BMT is often the only medical intervention option that offers patients a potential cure. Following BMT, patients are frequently subjected to multiple complications. Complications include regimen-related toxicity, toxicity, toxicity secondary to prophylactic and treatment procedures of adverse effects and complications, complications secondary to pancytopenia, and immunologic conflicts. These complications are primarily responsible for the morbidity and mortality associated with BMT. Infectious complications are usually viral, bacterial, or fungal and usually occur during the period of absolute neutropenia (less than 100/mm3neutrophils). Following BMT, approximately 10-20% of patients are at risk of developing fungal infections. Fungal infection is difficult to diagnose. Once fungal infections become invasive, treatment with appropriate antifungal therapy may not be effective. Prophylactic therapy against fungal infection is highly desirable to prevent the morbidity and mortality associated with fungal infection. Prophylactic therapy with low-dose amphotericin B, a first line agent for the treatment of systemic fungal infection, has been effective in reducing fungal infection after BMT. Low-dose amphotericin B therapy in BMT has also been shown to reduce the number of days of antibiotic therapy, reduce the number of day of high-dose amphotericin B, and reduce the number of days of hospitalization. These secondary endpoints may be associated with cost savings for patients. Audit worksheets of 35 patients undergoing BMT at the University of Utah Hospital were obtained. A data collection form was composed of clinical and cost-effective variables. Hospital charges were summarized for selected cost centers, antibiotic therapy, expensive medications, and total hospitalization. A cost-effectiveness analysis was performed to determine whether there were charge differences between the low-dose amphotericin B group and a placebo group and to determine whether low-dose amphotericin B was cost-effective. The decrease use of antibiotic therapy, the decrease use of high-dose amphotericin B, and a decrease in hospitalization with the use of low-dose amphotericin B all translated into cost savings for patients in the low-dose amphotericin B Study. Low-dose amphotericin B prophylaxis during the neutropenic period may therefore be cost-effective in patients at this institution. |
