Background: Invasive fungal infections (IFIs) in immunocompromised patients are associated with high mortality and treatment costs. Identifying appropriate, cost-effective treatment strategies is crucial to reduce the burden of IFIs. This economic assessment compared strategies for treating immunocompromised patients in Algeria and Egypt.Methods: We developed a decision analytic model incorporating clinical and cost inputs associated with a diagnostic-driven (DD) and standard empirical (SE) strategy. Costs and clinical outcomes were used to calculate incremental cost-effectiveness ratios (ICERs) per death avoided.Results: In both countries, 73.8 (DD) and 125.3 (SE) hypothetical patients per 1,000 received antifungal therapy; 73.8 (DD) and 32.7 (SE) had diagnosed IFIs. Survival at 180 days was similar between DD and SE strategies in Algeria (92.0% vs 91.6%) and Egypt (90.2% vs 90.0%). Total costs per patient were lower with the DD than SE strategy (Algeria: $839 vs $1,591; Egypt: $4,077 vs $4,717). ICERs indicated that the DD compared with SE strategy was associated with better clinical outcomes at a lower overall cost in both countries.Conclusion: Diagnostic-driven compared to empirical therapy may be cost-saving in Algeria and Egypt for the management of immunocompromised patients with persistent neutropenic fever, with no increase in mortality.

中文翻译：

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怀疑侵袭性真菌感染的免疫功能低下患者的治疗：阿尔及利亚和埃及诊断驱动与经验策略的经济分析。

背景：免疫功能低下患者的侵袭性真菌感染（IFI）与高死亡率和治疗费用相关。确定适当的，具有成本效益的治疗策略对于减轻IFI的负担至关重要。这项经济评估比较了阿尔及利亚和埃及的免疫功能低下患者的治疗策略。方法：我们开发了决策分析模型，该模型将临床和成本投入与诊断驱动（DD）和标准经验（SE）策略相关联。结果：在这两个国家中，每千人中有73.8（DD）和125.3（SE）个假性患者接受了抗真菌治疗；在这两个国家中，每千人接受抗真菌治疗的假设患者为73.8（DD）和125.3（SE）。73.8（DD）和32.7（SE）已诊断出IFI。阿尔及利亚DD和SE策略在180天生存率相似（92。0％比91.6％）和埃及（90.2％比90.0％）。DD治疗的每位患者总费用低于SE治疗（阿尔及利亚：839美元对1,591美元；埃及：4,077美元对4,717美元）。ICERs指出，在两个国家中，DD与SE策略相比具有更好的临床效果，且总成本较低。结论：在阿尔及利亚和埃及，以诊断为主导的治疗与经验性治疗相比可能节省成本，以治疗免疫力低下的持续性患者中性粒细胞减少，死亡率没有增加。