Two strategies for managing invasive aspergillosis: a decision analysis

Area of Science:

• Medical diagnostics
• Infectious disease management
• Medical imaging

Background:

• Invasive aspergillosis poses a significant risk to immunocompromised patients.
• Current diagnostic strategies rely on clinical symptoms and traditional imaging, often leading to delayed or empirical treatment.
• There is a need for earlier and more accurate diagnostic methods to guide antifungal therapy.

Purpose of the Study:

• To develop and evaluate a novel diagnostic approach for invasive aspergillosis.
• To compare the cost-effectiveness of this new strategy against the conventional approach.
• To identify factors influencing the economic viability of the proposed diagnostic method.

Main Methods:

• A decision analytic model was employed to compare strategies.
• The alternative strategy involved plasma screening for Aspergillus antigen using sandwich ELISA, thoracic CT, and radionuclide imaging.
• The conventional strategy relied on clinical symptoms, fever, and chest X-rays.

Main Results:

• The alternative strategy reduced empirical antifungal treatment but incurred higher costs.
• Sandwich ELISA specificity significantly impacted overall cost, while sensitivity did not.
• At a 13% infection prevalence, both strategies had equal costs.
• The alternative strategy was more cost-effective when more than 5.3% of patients received liposomal amphotericin B.

Conclusions:

• The proposed diagnostic approach offers potential benefits in managing invasive aspergillosis by optimizing antifungal treatment.
• Cost-effectiveness is sensitive to infection prevalence and the rate of empirical liposomal amphotericin B use.
• Further economic evaluation is warranted, considering specific clinical settings and patient populations.