Cost-effectiveness of posaconazole compared with standard azole therapy for prevention of invasive fungal infections in patients at high risk in Switzerland.
OBJECTIVE
To evaluate the cost-effectiveness of posaconazole versus standard azoles in the prevention of invasive fungal infection (IFI) in high-risk patients, using a pharmacoeconomic model that was adapted to a Swiss setting.


METHODS
Decision tree models based on the results of two registration trials and subsequent Markov models over patient lifetimes were developed for patients with acute myelogenous leukemia (AML) or myelodysplastic syndrome (MDS) with neutropenia and for hematopoietic stem cell transplant recipients with graft-versus-host disease (GVHD).


RESULTS
By reducing IFIs in AML/MDS patients with posaconazole prophylaxis, the contained IFI-related treatment costs more than compensated for the incremental cost of posaconazole, resulting in savings of CHF 1,118 per patient. Lifetime posaconazole prophylaxis resulted in a benefit of 0.16 life years saved per patient compared with fluconazole/itraconazole. In patients with GVHD, posaconazole prophylaxis prevented 0.04 IFIs, resulting in incremental costs of CHF 7,040 per patient. Lifetime posaconazole prophylaxis resulted in a benefit of 0.15 life years saved per patient, with an incremental cost-effectiveness rate of CHF 48,324 per life year saved.


CONCLUSIONS
Given the conditions of the Swiss setting, posaconazole can be considered a cost-effective early treatment strategy that increases survival in patients at risk for IFI and may have a substantial benefit for the economic burden of IFI.
Greiner
Roger-Axel
RA
Consultant Health Economics, Lörrach, Germany. Mail roger @ che-greiner.com
Meier
Yvonne
Y
Papadopoulos
George
G
O'Sullivan
Amy K
AK
Imhof
Alexander
A
D003362:Cost-Benefit Analysis; D003661:Decision Support Techniques; D006086:Graft vs Host Disease / Q000628:therapy; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D015470:Leukemia, Myeloid, Acute / Q000150:complications / Q000188:drug therapy; D008390:Markov Chains; D008962:Models, Theoretical; D009181:Mycoses / Q000191:economics / Q000517:prevention & control*; D009190:Myelodysplastic Syndromes / Q000150:complications / Q000188:drug therapy; D009503:Neutropenia / Q000150:complications / Q000188:drug therapy; D012306:Risk; D013557:Switzerland; D016896:Treatment Outcome; D014230:Triazoles / Q000191:economics* / Q000627:therapeutic use*
D014230:Triazoles; C101425:posaconazole