title: Economic evaluation of posaconazole versus fluconazole prophylaxis in patients with graft-versus-host disease (GVHD) in the Netherlands.
abstract: The objective of this study was to evaluate the cost-effectiveness of posaconazole versus fluconazole for the prevention of invasive fungal infections (IFI) in graft-versus-host disease (GVHD) patients in the Netherlands. A decision analytic model was developed based on a double-blind randomized trial that compared posaconazole with fluconazole antifungal prophylaxis in recipients of allogeneic HSCT with GVHD who were receiving immunosuppressive therapy (Ullmann et al., N Engl J Med 356:335-347, 2007). Clinical events were modeled with chance nodes reflecting probabilities of IFIs, IFI-related death, and death from other causes. Data on life expectancy, quality-of-life, medical resource consumption, and costs were obtained from the literature. The total cost with posaconazole amounted to <euro>9,428 (95% uncertainty interval <euro>7,743-11,388), which is <euro>4,566 (<euro>2,460-6,854) more than those with fluconazole. Posaconazole prophylaxis resulted in 0.17 (0.02-0.36) quality adjusted life year (QALY) gained compared to fluconazole prophylaxis, corresponding to an incremental cost effectiveness ratio (ICER) of <euro>26,225 per QALY gained. A scenario analysis demonstrated that at an increased background IFI risk (from 9% to 15%) the ICER was <euro>13,462 per QALY. Given the underlying data and assumptions, posaconazole prophylaxis is expected to be cost-effective relative to fluconazole in recipients of allogeneic HSCT developing GVHD in the Netherlands. The cost-effectiveness of posaconazole depends on the IFI risk, which can vary by hospital.
authors.affiliation: Mapi Values, 133 Portland Street, Boston, MA 02114, USA. Jeroen.jansen@mapivalues.com
authors.forename: Jeroen P
authors.initials: JP
authors.lastname: Jansen
authors.forename: Amy K
authors.initials: AK
authors.lastname: O'Sullivan
authors.forename: Elly
authors.initials: E
authors.lastname: Lugtenburg
authors.forename: Lambert F R
authors.initials: LF
authors.lastname: Span
authors.forename: Jeroen J W M
authors.initials: JJ
authors.lastname: Janssen
authors.forename: Wiro B
authors.initials: WB
authors.lastname: Stam
mesh_terms: D000328:Adult; D004311:Double-Blind Method; D005260:Female; D015725:Fluconazole / Q000008:administration & dosage* / Q000191:economics*; D006086:Graft vs Host Disease / Q000188:drug therapy* / Q000191:economics*; D006801:Humans; D008297:Male; D018803:Models, Economic; D009426:Netherlands; D019057:Quality-Adjusted Life Years; D014230:Triazoles / Q000008:administration & dosage* / Q000191:economics*
chemical_list: D014230:Triazoles; C101425:posaconazole; D015725:Fluconazole
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