Dr. Fungus:Antifungal therapy cost analysis

The cost of antifungal therapy is institution-, treatment setting-, and patient-specific. The information presented below serves as a general reference to cost issues associated with antifungal therapy.

On this page, three tables are provided comparing the U.S. average wholesale price (AWP) for antifungals:

Used to treat invasive infections,
Used to treat onychomycosis, and
Used as topical therapy.

All AWP pricing data were extracted from the 2006 Drug Topics Redbook (Published by Medical Economics, Inc. http://www.medec.com). Please note, the AWP does not necessarily reflect contract prices paid by individual institutions, which can vary widely based on antifungal usage and healthcare setting.

Acquisition costs are, however, only one component of the price of using any drug. If side effects or monitoring costs are significant, then these secondary cost considerations may outweigh the acquisition cost. Thus, we separately provide an analysis of the pharmacoeconomics of antifungal therapy, with a special emphasis on secondary costs associated with amphotericin B nephrotoxicity.

The following abbreviations are used in the tables below:
AMBd: amphotericin B deoxycholate (Fungizone)
ABLC: Amphotericin B lipid complex (Abelcet)
ABCD: Amphotericin B colloidal dispersion (Amphotec)
LAMB: Liposomal amphotericin B (AmBisome)

NA: Price not available

Table 1. Drugs Commonly Used in the Treatment of Invasive Fungal Infections

Drug	AWP Product Cost	Typical Doses	Estimated Daily Cost for 70 kg Patient
AMBd	$12 per 50 mg (10 ml vial)	0.5 mg/kg/day 1.0 mg/kg/day	$8 $17
ABLC	$135 per 50 mg (10 ml vial) $230 per 100 mg (20 ml vial)	5.0 mg/kg/day	$805
ABCD	$93 per 50 mg (20 ml vial) $160 per 100 mg (50 ml vial)	4.0 mg/kg/day	$448
LAMB	$188 per 50 mg vial	3.0 mg/kg/day 5.0 mg/kg/day 10 mg/kg/day	$790 $1,316 $2,632
Fluconazole	$0.88 per 100 mg tab $1.40 per 200 mg tab $32 per 35 ml oral suspension (10 mg/ml) $116 per 35ml oral suspension (40 mg/ml) [not generic] $64 per 400 mg IV	200 mg PO qd 400 mg PO qd 400 mg IV qd 800 mg IV qd	$14 $3 $64 $128
Itraconazole	$7 per 100 mg capsule $134 per 150 ml solution (10 mg/ml) $203 per 200 mg vial	200 mg day qd 200 mg IV bid 200 mg IV qd	$14 $406 $203
Ketoconazole	$3 per 200 mg tab	400-800 mg PO bid	$6-$12
Flucytosine	$9 per 500 mg capsule	25 mg/kg PO qid	$32
Caspofungin	$424 per 70 mg vial $329 per 50 mg vial	Loading dose of 70 mg on day#1, then 50 mg qd	$424 day 1, then $329 per day
Micafungin	$95 per 50 mg vial	50-150 mg/day	$95-280 per day
Anidulafungin	$90 per 50 mg vial	Loading dose of 100-200 mg on day#1, then 50-100 mg qd	$180-270 day 1, then $90-$180 per day
Voriconazole	$8 per 50 mg tablet $31.00 per 200 mg tablet $88 per 200 mg vial (20 ml) $563 per 75 mL solution (40 mg/ml)	Loading dose of 6 mg/kg IV q12h x 2 doses Maintenance 4 mg/kg IV q12h Oral maintenance 200 mg bid	$368 $245 $63
Posaconazole	$600 per 105 mL suspension (40 mg/mL)	600-800 mg/day in divided doses	$85-114

Table 2. Drugs Commonly Used in the Treatment of Onychomycosis

Drug	AWP Product Cost	Typical Treatment Course	Total Therapy Cost
Fluconazole	$0.88 per 100 mg tab $1.40 per 200 mg tab	150-300 mg PO qweek x 6-12 months	$37-$70
Itraconazole	$7 per 100 mg capsule "Pulse pack" dose formulation	200 mg PO qd x 3 month Pulse dosing:200 mg PO bid x 1 wk/month x 3-4 months	$1,260 $588-$784
Terbinafine	$8 per 250 mg tablet	250 mg PO qd x 12 weeks	$672
Griseofulvin	$1 per ultra-micronized 250 mg tablet	750-1000 mg PO qd 4-8 weeks	$84-$224

Table 3. Topical Antifungal Therapies

Group	Drugs	Rx or OTC	AWP Cost
Allylamines	Terbinafine	OTC	Cream (1%) 15 g-$33 Spray (1%) 30 ml-$67.20
Allylamines	Naftifine	Rx	Cream (1%) 15 g-$23
Azoles
	Ketoconazole	Rx	Cream (2%) 15g-$37 Shampoo (2%) 120 ml -$6
	Clotrimazole	Rx/OTC	Cream (1%) 15g-$11 Solution (1%) 10 ml-$20 Oral troche-$2.00
	Econazole	Rx	Cream (1%) 15g-$16
	Miconazole	OTC	Cream (2%) 15g-$17 Vaginal Suppos, (3 ct.) -$21
	Oxiconazole	Rx	Cream or lotion (1%) 15g-$17
	Sulconazole	Rx	Cream (1%) 15g-$12
	Terconazole	Rx	Terazole 3 day (0.8% suppos.)-$32 Terazole 7 day (0.4% cream)-$32
Polyenes	Amphotericin B (AmB)	Rx	Cream, Ointment (3%) 30g-$32 Lotion (3%) 20g -$35
	AmB Suspension	Rx	100 mg/ml- $30
	Topical Nystatin	Rx	Cream, Ointment 15g-$13 Powder 15g -$56
	Pimaricin	Rx	NA
Other Topical Drugs	Butenafine	RX	Cream(1%) 15 g-NA
	Ciclopirox-olamine	Rx	Cream, lotion (1%) 15g-$16
	Haloprogin	Rx	Cream(1%) 15g-$33 Solution(1%) 10 ml -$46
	Tolnaftate	OTC	Cream, Gel, Ointment (1%) 15g -$15 Powder(1%) 120g-$12 Spray (0.72mg/g)-$12
	Undecylenate	OTC	Cream, Ointment,others-$5-15 Foam (10%) -$5 Powder(10%)-$5