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You are here: Drugs > Medical >
  Content Director:  
Russell E. Lewis, Pharm.D. 
Russell E. Lewis, Pharm.D.  
Antifungal therapy cost analysis


What does it cost?

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:
  1. Used to treat invasive infections,
  2. Used to treat onychomycosis, and
  3. 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.

Acquisition cost of antifungals

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
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





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