title: Cost-effectiveness of posaconazole versus fluconazole or itraconazole in the prevention of invasive fungal infections among high-risk neutropenic patients in Spain.
abstract: BACKGROUND
  We evaluated the cost-effectiveness of posaconazole compared with standard azole therapy (SAT; fluconazole or itraconazole) for the prevention of invasive fungal infections (IFI) and the reduction of overall mortality in high-risk neutropenic patients with acute myelogenous leukaemia (AML) or myelodysplastic syndromes (MDS). The perspective was that of the Spanish National Health Service (NHS).
  
  
  METHODS
  A decision-analytic model, based on a randomised phase III trial, was used to predict IFI avoided, life-years saved (LYS), total costs, and incremental cost-effectiveness ratio (ICER; incremental cost per LYS) over patients' lifetime horizon. Data for the analyses included life expectancy, procedures, and costs associated with IFI and the drugs (in euros at November 2009 values) which were obtained from the published literature and opinions of an expert committee. A probabilistic sensitivity analysis (PAS) was performed.
  
  
  RESULTS
  Posaconazole was associated with fewer IFI (0.05 versus 0.11), increased LYS (2.52 versus 2.43), and significantly lower costs excluding costs of the underlying condition (€6,121 versus €7,928) per patient relative to SAT. There is an 85% probability that posaconazole is a cost-saving strategy compared to SAT and a 97% probability that the ICER for posaconazole relative to SAT is below the cost per LYS threshold of €30,000 currently accepted in Spain.
  
  
  CONCLUSIONS
  Posaconazole is a cost-saving prophylactic strategy (lower costs and greater efficacy) compared with fluconazole or itraconazole in high-risk neutropenic patients.
authors.affiliation: Hospital del Mar, Barcelona, Spain. sgrau@parcdesalutmar.cat
authors.forename: Santiago
authors.initials: S
authors.lastname: Grau
authors.forename: Rafael
authors.initials: R
authors.lastname: de la Cámara
authors.forename: Francisco J
authors.initials: FJ
authors.lastname: Sabater
authors.forename: Isidro
authors.initials: I
authors.lastname: Jarque
authors.forename: Enric
authors.initials: E
authors.lastname: Carreras
authors.forename: Miguel A
authors.initials: MA
authors.lastname: Casado
authors.forename: Miguel A
authors.initials: MA
authors.lastname: Sanz
mesh_terms: D000935:Antifungal Agents / Q000008:administration & dosage / Q000191:economics*; D018890:Chemoprevention / Q000191:economics* / Q000379:methods; D003362:Cost-Benefit Analysis; D019337:Hematologic Neoplasms / Q000150:complications; D006801:Humans; D016867:Immunocompromised Host; D017964:Itraconazole / Q000008:administration & dosage / Q000191:economics*; D009181:Mycoses / Q000453:epidemiology* / Q000401:mortality / Q000517:prevention & control*; D009503:Neutropenia / Q000150:complications*; D011446:Prospective Studies; D013030:Spain / Q000453:epidemiology; D014230:Triazoles / Q000008:administration & dosage / Q000191:economics*
chemical_list: D000935:Antifungal Agents; D014230:Triazoles; D017964:Itraconazole; C101425:posaconazole