Cost-effectiveness of posaconazole versus fluconazole or itraconazole in the prevention of invasive fungal infections among neutropenic patients in the United States.
OBJECTIVE
Clinical trial data indicate that posaconazole is superior to fluconazole (FLU) or itraconazole (ITRA) in preventing invasive fungal infections (IFIs) among neutropenic patients. Our objective was to assess the cost-effectiveness of posaconazole versus FLU or ITRA for prevention of IFIs among neutropenic patients.


METHODS
We used modeling techniques to assess the cost-effectiveness of posaconazole versus FLU or ITRA in the prevention of IFIs among patients with acute myelogenous leukemia (AML) or myelodysplastic syndromes (MDS) and chemotherapy-induced neutropenia. The probabilities of experiencing an IFI, IFI-related death, and death from other causes over 100 days of follow-up were estimated from clinical trial data. Long-term mortality, drug costs, and IFI treatment costs were obtained from secondary sources.


RESULTS
Posaconazole is associated with fewer IFIs per patient (0.05 vs. 0.11) relative to FLU or ITRA over 100 days of follow-up, and lower discounted costs ($3900 vs. $4500) and increased life-years (2.50 vs. 2.43 discounted) over a lifetime horizon. Results from a probabilistic sensitivity analysis indicate that there is a 73% probability that posaconazole is cost saving versus FLU or ITRA and a 96% probability that the incremental cost-effectiveness ratio for posaconazole is at or below $50,000 per life-year saved.


CONCLUSIONS
We conclude that posaconazole is very likely to be a cost-effective alternative to FLU or ITRA in the prevention of IFIs among neutropenic patients with AML and MDS, and may result in cost savings.
O'Sullivan
Amy K
AK
i3 Innovus, Medford, MA, USA. amy.osullivan@i3innovus.com
Pandya
Ankur
A
Papadopoulos
George
G
Thompson
David
D
Langston
Amelia
A
Perfect
John
J
Weinstein
Milton C
MC
D000935:Antifungal Agents / Q000191:economics* / Q000627:therapeutic use; D017046:Cost Savings / Q000191:economics; D003362:Cost-Benefit Analysis; D003661:Decision Support Techniques; D016527:Drug Costs; D005260:Female; D015725:Fluconazole / Q000191:economics* / Q000627:therapeutic use; D006801:Humans; D017964:Itraconazole / Q000191:economics* / Q000627:therapeutic use; D015993:Life Tables; D008297:Male; D008875:Middle Aged; D017059:Models, Econometric; D009181:Mycoses / Q000191:economics / Q000209:etiology / Q000517:prevention & control*; D009503:Neutropenia / Q000150:complications* / Q000191:economics; D014481:United States
D000935:Antifungal Agents; D017964:Itraconazole; D015725:Fluconazole