Aquarius Population Health

Problem: Our client’s drug is recommended in most guidelines as a first line treatment for invasive fungal infections in immunocompromised patients. But because its acquisition cost can be comparatively high, health care purchasers have tended to favour its lower-cost competitors. To challenge this perception, our client wanted to know what the total healthcare costs were of treating patients with invasive fungal infection with its drug compared to alternatives, and to help customers understand the wider costs of patient management.

Approach: We took a two-pronged approach. First, we assembled a multidisciplinary team, to work closely with our client’s market access and medical teams in the UK, Ireland, and internationally. We reviewed the published evidence base of the side-effects, effectiveness and costs of its drug and its alternatives, and built a simple, user-friendly Excel tool that could be used with their customers to demonstrate the total treatment costs of theirs and competitors’ drugs. National data for the baseline values in the tool were used, but we incorporated a simple interface so that customers could use local patient data and costs for a personalised result.

Next, we worked with clinicians at Kings College Hospital NHS Foundation Trust to analyse data collected prospectively as part of a study of haematology patients receiving antifungal treatment in hospital. This patient level analysis explored the costs of antifungal and antibiotic drugs, diagnostic tests, and hospital stay. We found that the driver of costs was the underlying inpatient stay, which was much higher than the cost of antifungal drugs.

Impact: Our client’s sales team have reported that our tool has been integral in their work and as part of their evidence base. They can help their customers understand the total costs of different treatment strategies, and it has prompted several clinics to audit their own local data and then use it in the tool to estimate the impact of drug use on their overall costs. Results from the analysis at Kings College Hospital provided much needed evidence of the costs of care for IFD patients, which can be used to inform local and national tariffs. More generally, the project has helped raise awareness of the wider issues of cost, rather than focusing on the drug acquisition cost alone.



“Through working with Elisabeth and her team I have been able to develop excellent tools which have been relevant to our customers and valuable to our sales team. Aquarius is flexible to my needs and able to adapt their approach as situations and demands change. I have always found Elisabeth to be very knowledgeable and professional and I thoroughly enjoy the partnership we have developed. I would definitely recommend working with Aquarius!”

  • Manager, Market Access & Reimbursement, pharmaceutical company

“The Aquarius team conducted an analysis of individual patient data from our hospital. They were very proactive and responsive throughout our collaboration, and although we had quite complicated data, they delivered excellent results ending in a peer-reviewed publication.”

  • Dr Tony Pagliuca, Clinical and Transplant Director, Chair of DH BMT CRG, and Professor of Stem Cell Transplantation, King’s College Hospital NHS Foundation Trust
  • Dr M. Mansour Ceesay, Consultant Haematologist, King’s College Hospital NHS Foundation


Related publications

publication_iconCeesay MM, Sadique Z, Harris, R, Ehrlich A, Adams EJ, Pagliuca A. Prospective Evaluation Of The Cost Of Diagnosis And Treatment Of Invasive Fungal Disease In A Cohort Of Adult Haematology Patients In The United Kingdom. J Antimicrobial Chemotherapy. 2014; doi: 10.1093/jac/dku506.

presentation_iconAdams EJ, Kendall E, Horner J, Marsh R. Thinking critically about the value and cost of drugs: managing patients with invasive fungal disease. ECCMID 2015. 25 – 28 April 2015. Copenhagen, Denmark.

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