title: [Economic evaluation of posaconazole in prophylaxis of invasive fungal infections in Italian neutropenic patients with acute myeloid leukaemia or myelodysplastic syndrome].
abstract: The objective of this study was to assess the costs and effectiveness (avoided invasive fungal infections - IFIs; overall mortality) of prophylaxis with posaconazole 200 mg per os TID and standard azoles (fluconazole 400 mg per os OD, itraconazole 200 mg per os BID) in neutropenic patients with acute myelogenous leukaemia or myelodysplastic syndromes. A 100-day cost-effectiveness model was developed following the Italian hospital perspective. The probability of IFIs, death from IFIs, and death from other causes was obtained from the literature. Health care sector resources (type, volume, unit cost) are given in Euros and refer to 2009. The robustness of the cost-effectiveness model was tested via one-way and probabilistic sensitivity analyses. Total costs for posaconazole (standard azoles) was estimated at Euros 3365.26 (Euros 2339.96). Posaconazole is consistently more effective than standard azoles. The incremental cost-effectiveness ratio for avoided IFI (avoided overall mortality) with posaconazole is Euros 15,850.51 (Euros 18,038.43). Sensitivity analyses confirmed the robustness of such findings. In conclusion, posaconazole as a prophylaxis in neutropenic patients with AML or MDS who are at risk of IFI is good value for money for Italian hospitals.
authors.affiliation: Studio di Economia Sanitaria, Milan, Italy.
authors.forename: Carlo
authors.initials: C
authors.lastname: Lazzaro
mesh_terms: D000284:Administration, Oral; D000666:Amphotericin B / Q000627:therapeutic use; D000935:Antifungal Agents / Q000191:economics* / Q000627:therapeutic use; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use; D003362:Cost-Benefit Analysis; D003840:Deoxycholic Acid / Q000627:therapeutic use; D004338:Drug Combinations; D016527:Drug Costs; D004864:Equipment and Supplies / Q000191:economics; D015725:Fluconazole / Q000191:economics / Q000627:therapeutic use; D005500:Follow-Up Studies; D017721:Hospital Costs; D006801:Humans; D016867:Immunocompromised Host; D007262:Infusions, Intravenous / Q000191:economics; D007558:Italy / Q000453:epidemiology; D017964:Itraconazole / Q000191:economics / Q000627:therapeutic use; D015470:Leukemia, Myeloid, Acute / Q000150:complications*; D009181:Mycoses / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D009190:Myelodysplastic Syndromes / Q000150:complications*; D009503:Neutropenia / Q000139:chemically induced / Q000150:complications*; D009859:Oncology Nursing / Q000191:economics; D016896:Treatment Outcome; D014230:Triazoles / Q000191:economics* / Q000627:therapeutic use
chemical_list: D000935:Antifungal Agents; D004338:Drug Combinations; D014230:Triazoles; D003840:Deoxycholic Acid; D017964:Itraconazole; C101425:posaconazole; D000666:Amphotericin B; C059765:amphotericin B, deoxycholate drug combination; D015725:Fluconazole