Cost advantage of voriconazole over amphotericin B deoxycholate for primary treatment of invasive aspergillosis.
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.
Lewis
James S
JS
Department of Pharmacy, University of Texas Health Science Center at San Antonio, University Health System, San Antonio, Texas, USA. james.lewis@uhs-sa.com
Boucher
Helen W
HW
Lubowski
Teresa J
TJ
Ambegaonkar
Ambarish J
AJ
Day
David L
DL
Patterson
Thomas F
TF
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
D000935:Antifungal Agents; D004338:Drug Combinations; D011743:Pyrimidines; D014230:Triazoles; D003840:Deoxycholic Acid; D000666:Amphotericin B; C059765:amphotericin B, deoxycholate drug combination; D065819:Voriconazole