A Comparative Study Of Efficacy And Cost-effectiveness Of Caspofungin And Micafungin In The Treatment Of Hematological Malignancies With Invasive Fungal Disease

To investigate clinical features and pathogenic distributions of invasive fungal diseases in patients with hematologic malignancies,analyze risk factors of the therapeutic effect,the usage and pharmacoeconomic analysis of caspofungin and micafungin in order to provide reference for clinical diagnosis and treatment.The clinical data of 180 cases of invasive fungal diseases in patients with hematologic malignancies,who use caspofungin or micafungin were treated in the hospital from Jan 2014 to Dec 2015,were retrospectively analyzed,and the pathogenic distributions,infectious sites,therapeutic effect,hospitalization cost,risk factors and use of caspofungin and micafungin were statistical analyzed by the use of software SPSS 21.0.Totally 75 fungal strains were isolated from the 180 patients,including Candida albicans(69.34%)and aspergillus(19.33%);and the lung were the main infection sites(93.88%).The total cure rate was 44.44%,and the IFD related mortality was 15.00%.The therapeutic effect was negatively correlated with more than three broad-spectrum antibiotics and hypohepatia,they were the independent impact factors related to therapy;The irrational use of antifungal agents included lack of loading dose and dosage,the unreasonable utilization rate of caspofungin and micafungin was 72.74% and 5.22% respectively.Caspofungin's total cost was 273709.08 yuan,and the total cost of micafungin was 227156.05 yuan;the total effective rate of caspofungin and micafungin was 35.00% and 71.67%.Based on the total effective rate,the cost-effectiveness ratio of caspofungin and micafungin was 7820.26 and 3169.47 respectively,incremental cost-effectiveness ratio was-1269.51,caspofungin drop a curative effect unit spent 1269.51 yuan;micafungin is more cost-effectiveness advantage than caspofungin,micafungin is the best dosage regimen for IFD.The antifungal agents were safe,no adverse reaction occurred during the application periods.The Candida albicans is the predominant species of pathogens causing invasive fungal infections in patients with hematologic malignancies.The main risk factors are application of broad-spectrum antibiotics and hypohepatia.It is important to focus on the patients with liver dysfunction and strengthen the reasonable applications of broad-spectrum antibiotics.The unreasonable use of caspofungin and micafungin is relatively common,usage and dosage,should be noted,and strengthen the supervision of antifungal agents use.Compared to caspofungin,micafungin is an effective,safety,economical regimen for treating hematological malignancies with invasive fungal diseases.