Richard P. Wenzel

Objective: The objective of this study was to conduct an economic evaluation of voriconazole compared with conventional amphotericin B deoxycholate (CAB) using data from a recently reported randomized comparative trial in patients with various underlying immunosuppressive conditions. This trial demonstrated the superiority of voriconazole in terms of clinical response, survival and safety when used as primary therapy for invasive aspergillosis. Methods: A decision analytic model was designed using an expert panel and populated primarily with efficacy and resource utilization data collected prospectively during the clinical trial. The analysis was carried out from the perspective of the health care system and all costs are reported in 2002 US dollars. Results: Average total treatment costs per patient were 10% lower in the voriconazole arm ($30 664) than in the CAB arm ($34 144), resulting from reduced consumption of hospital resources and fewer changes in antifungal therapy. In the base case analysis, voriconazole provided an average saving of $3481 per treated patient, resulted in a lower cost per survivor ($43 310 versus $58 971) and a lower cost per successfully treated patient ($58 100 versus $108 124) compared with CAB. Sensitivity analyses demonstrated that the cost savings observed were maintained over a wide range of alternative values for both unit costs and resource utilization, including length of hospital stay, time spent in intensive care units, bed day costs and the cost of lipid formulations of amphotericin B. Conclusion: Incremental cost-effectiveness analysis indicated the dominance of voriconazole because of both lower costs and greater efficacy.

Book Review from The New England Journal of Medicine — Book Review

Patients with fever and neutropenia are at high risk for infection (∼50%) and bacteremia (∼20%). As a result, most are treated with antibacterial prophylaxis until their absolute neutrophil count exceeds 500 cells/mm³ and their temperature returns to normal. The 1997 guidelines of the Infectious Diseases Society of America suggested 1 of 3 regimens: vancomycin plus ceftazidime, monotherapy with ceftazidime or imipenem (possibly cefepime or meropenem), or dual therapy with an aminoglycoside plus an antipseudomonal β-lactam [1].

Volume 7, Number 2—April 2001 - Emerging Infectious Disease journal - CDC

Research from JAMA Internal Medicine — Handwashing Compliance by Health Care Workers — The Impact of Introducing an Accessible, Alcohol-Based Hand Antiseptic

Candida species are the fourth most frequent cause of nosocomial bloodstream infections, and 25%–50% occur in critical care units. During an 18-month

Richard P. Wenzel; Introduction, Clinical Infectious Diseases, Volume 29, Issue 2, 15 July 1999, Pages 238, https://doi.org/10.1086/520191