Economic evaluation of voriconazole versus caspofungin for the treatment of invasive aspergillosis in Spain.
OBJECTIVE
Invasive fungal infections are becoming increasingly prevalent and are more frequently the aetiological agents responsible for nosocomial infections. Since mid-2002, two new antifungal drugs - voriconazole, a third-generation azole, and caspofungin, a member of a new class of drugs called echinocandins - have been marketed in Spain. Both drugs have proven [corrected] efficacy in the treatment of aspergillosis, are better tolerated than amphotericin B and are cheaper [corrected] than liposomal amphotericin B. The objective of this study was to conduct an economic evaluation of voriconazole versus caspofungin for the treatment of invasive aspergillosis in Spain.


METHODS
This was a cost-minimisation analysis (2006 costs) from the hospital perspective. Duration of treatment and bodyweight of patients were obtained from the Fungcost study and the incidence of adverse events was obtained from different published sources. Only direct costs were considered. Mean expected cost and incremental cost were calculated, and univariate and bivariate (bodyweight/treatment duration) sensitivity analyses were conducted.


RESULTS
The mean expected cost per episode was 6041.93 euro (intravenous treatment acquisition cost 5524.75 euro) for voriconazole and 7174.05 euro (intravenous treatment acquisition cost 6672.80 euro) for caspofungin in invasive aspergillosis; the incremental cost was 1132.18 euro. Results were robust for any treatment duration and sensitive to bodyweights <103.42 kg.


CONCLUSIONS
Voriconazole is a more cost-effective option than caspofungin in invasive aspergillosis in patients with a bodyweight <103.42 kg.
Domínguez-Gil
Alfonso
A
Servicio de Farmacia, Hospital Universitario de Salamanca, Salamanca, Spain.
Martín
Isabel
I
García Vargas
Mercedes
M
Del Castillo
Almudena
A
Díaz
Silvia
S
Sánchez
Cristina
C
D000284:Administration, Oral; D000935:Antifungal Agents / Q000191:economics / Q000627:therapeutic use; D001228:Aspergillosis / Q000188:drug therapy* / Q000473:pathology / Q000503:physiopathology; D001835:Body Weight; D000077336:Caspofungin; D003362:Cost-Benefit Analysis; D054714:Echinocandins; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006801:Humans; D007275:Injections, Intravenous; D055666:Lipopeptides; D015999:Multivariate Analysis; D010456:Peptides, Cyclic / Q000008:administration & dosage / Q000191:economics / Q000627:therapeutic use*; D011743:Pyrimidines / Q000008:administration & dosage / Q000191:economics / Q000627:therapeutic use*; D012720:Severity of Illness Index; D013030:Spain; D016896:Treatment Outcome; D014230:Triazoles / Q000008:administration & dosage / Q000191:economics / Q000627:therapeutic use*; D065819:Voriconazole
D000935:Antifungal Agents; D054714:Echinocandins; D055666:Lipopeptides; D010456:Peptides, Cyclic; D011743:Pyrimidines; D014230:Triazoles; D000077336:Caspofungin; D065819:Voriconazole