title: Cost advantage of voriconazole over amphotericin B deoxycholate for primary treatment of invasive aspergillosis.
abstract: OBJECTIVE
  Using data from a published clinical trial, our objectives were to compare the cost advantage of voriconazole over amphotericin B deoxycholate (AmBd) for primary treatment of invasive aspergillosis and to determine the financial impact the findings would have in a real-world clinical setting.
  
  
  METHODS
  Pharmacoeconomic analysis.
  
  
  METHODS
  University hospital.
  
  
  METHODS
  Two hundred seventy-seven patients in the modified intent-to-treat population.
  
  
  RESULTS
  An analysis was performed of drug acquisition costs for all patients in the modified intent-to-treat population, which consisted of 144 patients in the voriconazole group and 133 in the AmBd group. The analysis included costs of initial drug therapy; conversion from intravenous to oral treatment for patients receiving voriconazole; and the types, dosages, and duration of other licensed [Food and Drug Administration-approved] antifungal therapy (OLAT) for up to three OLAT regimens/patient. Current drug costs for our university hospital were used for all calculations. Total voriconazole costs were $784,405 ($581,008 for initial therapy with voriconazole, $203,397 for OLAT) compared with $852,238 for AmBd ($31,677 for initial AmBd therapy, $820,561 for OLAT). Over the 12-week study period, the cost/patient was $961 less for patients whose initial treatment was voriconazole than for those whose initial treatment was AmBd. Other licensed antifungal therapy accounted for 26% and 96% of total drug costs for voriconazole and AmBd, respectively. Other licensed antifungal therapy was given to 36% of voriconazole-treated patients and 80% of AmBd-treated patients.
  
  
  CONCLUSIONS
  These data demonstrate the importance of evaluating total drug costs when comparing treatment regimens and not just initial therapy. Initial therapy with voriconazole had a cost advantage over AmBd in total antifungal drug cost/patient.
authors.affiliation: Department of Pharmacy, University of Texas Health Science Center at San Antonio, University Health System, San Antonio, Texas, USA. james.lewis@uhs-sa.com
authors.forename: James S
authors.initials: JS
authors.lastname: Lewis
authors.forename: Helen W
authors.initials: HW
authors.lastname: Boucher
authors.forename: Teresa J
authors.initials: TJ
authors.lastname: Lubowski
authors.forename: Ambarish J
authors.initials: AJ
authors.lastname: Ambegaonkar
authors.forename: David L
authors.initials: DL
authors.lastname: Day
authors.forename: Thomas F
authors.initials: TF
authors.lastname: Patterson
mesh_terms: D000284:Administration, Oral; D000666:Amphotericin B / Q000191:economics* / Q000627:therapeutic use; D000935:Antifungal Agents / Q000191:economics* / Q000627:therapeutic use; D001228:Aspergillosis / Q000188:drug therapy / Q000191:economics*; D003840:Deoxycholic Acid / Q000191:economics* / Q000627:therapeutic use; D004338:Drug Combinations; D017850:Economics, Pharmaceutical; D006801:Humans; D007275:Injections, Intravenous; D015337:Multicenter Studies as Topic; D011743:Pyrimidines / Q000191:economics* / Q000627:therapeutic use; D016032:Randomized Controlled Trials as Topic; D014230:Triazoles / Q000191:economics* / Q000627:therapeutic use; D065819:Voriconazole
chemical_list: D000935:Antifungal Agents; D004338:Drug Combinations; D011743:Pyrimidines; D014230:Triazoles; D003840:Deoxycholic Acid; D000666:Amphotericin B; C059765:amphotericin B, deoxycholate drug combination; D065819:Voriconazole