Successful outpatient parenteral antimicrobial therapy with rezafungin for chronic pulmonary aspergillosis: a case report and health economic assessment.

Background: Chronic pulmonary aspergillosis (CPA) is a serious lung disorder caused by Objectives: To report a case where rezafungin was potentially effective in managing CPA for a patient with limited treatment options, and to estimate the health economic impact of rezafungin versus once-daily echinocandin in an OPAT setting. Patients and methods: We discuss a patient with CPA, diagnosed in 2020, with frequent episodes of haemoptysis, dyspnoea, productive cough and lethargy with progressive bilateral pulmonary cavitatory lesions and nodules treated with rezafungin over 12 weeks via OPAT. Costs to deliver once-weekly rezafungin compared with once-daily caspofungin in the OPAT clinic were compared. Results: Symptoms improved significantly after 12 weeks of rezafungin, with no further emergency visits, versus eight in the year prior due to CPA symptoms. Aspergillus serology (IgG) improved and computerized tomography imaging showed slight improvement in the degree of consolidation surrounding the cavities. Daily OPAT costs increased by £13.71 for rezafungin compared with caspofungin. This was offset by greater patient convenience and improved OPAT clinic capacity. Conclusions: Rezafungin may be a novel, well-tolerated and cost-effective echinocandin treatment for CPA in patients needing OPAT and with limited treatment options. Further clinical studies are required for robust evaluation of this novel echinocandin in CPA.