Economic Evaluation of Posaconazole Versus Fluconazole or Itraconazole in the Prevention of Invasive Fungal Infection in High-Risk Neutropenic Patients in Sweden
2014 (English)In: Clinical drug investigation, ISSN 1173-2563, Vol. 34, no 7, 483-489 p.Article in journal (Refereed) Published
Background In patients undergoing induction chemotherapy for acute myeloid leukemia (AML) or myelodysplastic syndromes (MDS), posaconazole has been proven more effective in the prevention of invasive fungal infection (IFI) than fluconazole or itraconazole (standard azoles) The current analysis seeks to estimate the cost effectiveness of prophylactic posaconazole compared with standard azoles in AML or MDS patients with severe chemotherapyinduced neutropenia in Sweden. Methods A decision-analytic model was used to estimate life expectancy, costs, and quality-adjusted life-years (QALYs). Efficacy data were derived from a phase III clinical trial. Life expectancy and quality of life data were collected from the literature. A modified Delphi method was used to gather expert opinion on resource use for an IFI. Unit costs were captured from hospital and pharmacy pricelists. A probabilistic sensitivity analysis (PSA) was used to investigate the impact of uncertainty in the model parameters on the cost-effectiveness results. Results The estimated mean direct cost per patient with posaconazole prophylaxis was 46,8(3 Swedish kronor (SEK) (epsilon 5,387) and SEK50,017 (epsilon 5,746) with standard azoles. Prophylaxis with posaconazole resulted in 0.075 QALYs gained compared with standard azoles. At a cost-effectiveness threshold of SEK500,000/QALY the PSA demonstrated a more than (5 % probability that posaconazole is cost effective versus standard azoles for the prevention of IFI in high-risk neutropenic patients in Sweden. Conclusion Given the assumptions, methods, and data used, posaconazole is expected to be cost effective compared with standard azoles when used as antifungal prophylaxis in AML or MDS patients with chemotherapyinduced prolonged neutropenia in Sweden.
Place, publisher, year, edition, pages
2014. Vol. 34, no 7, 483-489 p.
Pharmacology and Toxicology
IdentifiersURN: urn:nbn:se:uu:diva-239612DOI: 10.1007/s40261-014-0199-9ISI: 000344604700006PubMedID: 24820968OAI: oai:DiVA.org:uu-239612DiVA: diva2:774901