Economic evaluation of voriconazole versus conventional amphotericin B in the treatment of invasive aspergillosis in Germany.
OBJECTIVE
To assess the costs and cost-effectiveness of voriconazole in comparison to conventional amphotericin B (CAB) for the treatment of invasive aspergillosis in Germany.


METHODS
The cost-effectiveness of voriconazole in comparison to CAB was evaluated with a lifetime Markov model, focusing on the long-term survival of patients treated for invasive aspergillosis. Long-term survival was extrapolated from survival after 12 weeks of treatment, obtained from a randomized aspergillosis study. Information on medical resource consumption and treatment pathways were obtained from this study and an expert committee. With probabilistic analysis the cost-effectiveness of voriconazole compared with amphotericin B was analyzed and expressed in incremental costs per life-weeks gained. The evaluation was performed from a limited societal perspective (both inpatient and outpatient costs) and hospital perspective (only inpatient costs).


RESULTS
Average survival of patients treated with voriconazole was 174.4 life-weeks (95% confidence interval [CI] 159.4-191.3), compared with 119.4 life-weeks (95% CI 106.4-132.3) for amphotericin B. With voriconazole, the mean total costs per patient were 30,026 euros (95% CI 23 euros ,118-37,947) compared with 26,669 euros for amphotericin B (95% CI 21,259-34,263 euros ) from the limited societal perspective. The corresponding incremental cost-effectiveness ratio was 62 euros per life-week gained (i.e., 3224 euros per life-year gained). Hospital costs were approximately 90% of the mean total costs.


CONCLUSIONS
In the treatment of invasive aspergillosis, voriconazole is cost-effective in comparison to amphotericin B. Hospital costs are comparable for both treatments and are expected to be reimbursed based on the German diagnosis-related groups (DRG) system 2005.
Jansen
Jeroen P
JP
Mapi Values, Houten, The Netherlands. Jeroen.jansen@mapivalues.com
Kern
Winfried V
WV
Cornely
Oliver A
OA
Karthaus
Meinolf
M
Ruhnke
Markus
M
Ullmann
Andrew J
AJ
Resch
Ansgar
A
D000666:Amphotericin B / Q000191:economics / Q000627:therapeutic use*; D000935:Antifungal Agents / Q000191:economics / Q000627:therapeutic use*; D001228:Aspergillosis / Q000188:drug therapy* / Q000191:economics / Q000401:mortality; D017281:Cost of Illness; D003362:Cost-Benefit Analysis; D003663:Decision Trees; D005858:Germany; D017048:Health Care Costs; D006801:Humans; D016867:Immunocompromised Host; D008390:Markov Chains; D017059:Models, Econometric; D011743:Pyrimidines / Q000191:economics / Q000627:therapeutic use*; D016019:Survival Analysis; D014230:Triazoles / Q000191:economics / Q000627:therapeutic use*; D065819:Voriconazole
D000935:Antifungal Agents; D011743:Pyrimidines; D014230:Triazoles; D000666:Amphotericin B; D065819:Voriconazole