Availability and cost of antifungal therapy in Vietnam: A 5-year retrospective study

Access to antifungal agents for the treatment of invasive fungal infections (IFIs) varies significantly between countries. Limited access or high cost may contribute to the burden of IFIs. We aimed to investigate the availability and cost of antifungal treatment for IFIs in Vietnam. Procurement data from 2018 to 2022 was collected from the Drug Administration of Vietnam website. We calculated the cost per defined daily dose (DDD) and identified the manufacturing countries. We explored the pharmacotherapy cost of the four major IFIs if first-line agents were used in accordance with the Vietnam 2021 antifungal prescribing guideline. We also estimated the treatment expenditure in 2020 based on the estimated disease burden previously published and suggested cost-saving measures. At least 57.6 million USD was spent on 15.5 million DDD of antifungals in 5 years. Seven systemic antifungal agents were available in Vietnam. Caspofungin and micafungin were the least used but most expensive, whereas fluconazole and itraconazole were the most consumed but cheapest antifungals. Vietnam manufactured 70% of azole antifungals and relied on imports for the remaining antifungals consumed. We estimated the first-line pharmacological treatment for the estimated cases of four IFIs in 2020 to cost at least 209.1 million USD, which exceeded the actual spend in 2020. We discovered that antifungal agents for IFIs impose a substantial economic burden on Vietnam's healthcare system. We highlight the need for cost-effectiveness studies of expensive first-line medications. Efforts to mitigate this economic burden should include antifungal stewardship, prevention of IFIs, and sourcing from cost-effective manufacturers.