title: Posaconazole vs fluconazole/itraconazole in the prophylaxis of invasive fungal infections in immunocompromised patients: a cost-effectiveness analysis in Greece.
abstract: BACKGROUND
  Invasive fungal infections (IFIs) present a major issue in clinical practice, due to their high morbidity and mortality rates. In a pivotal multi-centre, randomized clinical trial, posaconazole prophylaxis prevented IFIs more effectively than did either fluconazole or itraconazole, and improved overall survival.
  
  
  OBJECTIVE
  The aim of this study was to perform an economic evaluation of the aforementioned therapeutic strategies for IFI prophylaxis in neutropenic patients, in the Greek healthcare setting.
  
  
  METHODS
  A decision analytic model was developed, which described the course of neutropenic patients under posaconazole or standard azole (fluconazole or itraconazole) treatment. Effectiveness data for each treatment regimen were derived from published results of a pivotal, multi-centre, randomized clinical trial. Cost and healthcare resources utilization data depict Greek clinical practice and are derived from official Greek sources, from a third party payer perspective.
  
  
  RESULTS
  Prophylaxis with posaconazole resulted in fewer IFIs (0.05 vs 0.11 per patient) compared to treatment with fluconazole or itraconazole, during the first 100 days from initiation of prophylaxis treatment. The cost per avoided IFI with posaconazole was €6455, while the incremental cost per life year gained (LYG) was estimated at €24,196. Extensive sensitivity analyses corroborated the base-case results. Possible limitations of the study are the exclusion of indirect and outpatient costs from the analysis and the inherent uncertainty with regards to the transferability of the clinical efficacy results of the clinical trial to the Greek healthcare setting.
  
  
  CONCLUSIONS
  The utilization of posaconazole for prophylaxis of IFIs neutropenic patients is a therapeutic strategy that provides superior clinical efficacy, while being cost-effective compared to alternative therapies.
authors: Department of Health Economics, National School of Public Health, Athens, Greece. kathanasakis@esdy.edu.gr
authors: K
authors: K
authors: Athanasakis
authors: I
authors: I
authors: Petrakis
authors: J
authors: J
authors: Kyriopoulos
mesh_terms: D000935:Antifungal Agents / Q000191:economics* / Q000627:therapeutic use; D003362:Cost-Benefit Analysis; D003661:Decision Support Techniques; D015725:Fluconazole / Q000191:economics* / Q000627:therapeutic use; D006115:Greece / Q000453:epidemiology; D005102:Health Expenditures; D006801:Humans; D016867:Immunocompromised Host; D017964:Itraconazole / Q000191:economics* / Q000627:therapeutic use; D018803:Models, Economic; D009181:Mycoses / Q000453:epidemiology / Q000517:prevention & control*; D009503:Neutropenia / Q000453:epidemiology; D014230:Triazoles / Q000191:economics* / Q000627:therapeutic use
chemical_list: D000935:Antifungal Agents; D014230:Triazoles; D017964:Itraconazole; C101425:posaconazole; D015725:Fluconazole