OBJECTIVES: Incidence of invasive fungal infections (IFI) often occurs as a complication of immunosuppression in patients with hematological malignancies. These infections reflect an important cause of morbidity and mortality in patients with Acute Myeloid Leukemia (AML) and in hematopoietic stem cell transplant (HSCT) recipients. Early diagnosis and treatment of patients with an IFI can have a major impact on patient outcomes. For this reason, new approaches for diagnosis and treatment have been developed. However, due to lack of accurate diagnostic tools for making an early diagnosis, the debate is still ongoing about how and when to initiate therapy. Notably, the empirical approach advocates to begin antifungal therapy for those patients who have fever lasting 4–7 days despite using broad-spectrum antibiotics. The preemptive approach concerns initiation of antifungal therapy for patient after considering clinical and mycological evidence pointing to a highly probable IFI. The aim of this study is to compare both alternatives in terms of cost-effectiveness.

METHODS: A decision tree was developed according to the Turkish reimbursement authority’s perspective. The data used in the model were derived from the published literature and specific Turkish sources. Cost-effectiveness was expressed as net costs per extra surviving patient.

RESULTS: It was found that the preemptive approach is less costly, but the empirical approach more effective. Ergo, none of the methods was dominant. Cost-effectiveness of the empirical approach as compared to the preemptive one was estimated at TR186,577.

CONCLUSIONS: Major shares of the costs of the preemptive approach to patient with suspected IFI concern the CT-scan with contrast media increased nephrotoxicity. If CT-scans would be made without contrast media though, costs of the preemptive method can be reduced with only slight reductions in effectiveness and the preemptive method might be considered preferably with huge cost savings associated (ICER at -TR19,124,297).