title: Pharmacoeconomic evaluation of fluconazole, posaconazole and voriconazole for antifungal prophylaxis in patients with acute myeloid leukaemia undergoing first consolidation chemotherapy.
abstract: BACKGROUND
  Fluconazole, posaconazole and voriconazole are used prophylactically in patients with acute myeloid leukaemia (AML). This study evaluated the clinical and economic outcomes of these agents when used in AML patients undergoing consolidation chemotherapy.
  
  
  METHODS
  A retrospective chart review (2003-10) of AML patients receiving consolidation chemotherapy was performed. Patients were followed through their first cycle of consolidation chemotherapy. Antifungal prescribing patterns, clinical outcomes and resource consumptions were recorded. A decision analytical model was developed to depict the downstream consequences of using each antifungal agent, with success defined as completion of the designated course of initial antifungal prophylaxis without developing invasive fungal disease (IFD). Cost-effectiveness and sensitivity analyses were performed.
  
  
  RESULTS
  A total of 106 consecutive patients were analysed. Baseline characteristics and predisposing factors for IFD were comparable between groups. Three IFDs (one proven, one probable and one suspected) occurred, all in the posaconazole group. Patients receiving posaconazole had the highest rate of intolerance requiring drug cessation (13% versus 7% in each of the fluconazole and voriconazole groups). Fluconazole conferred overall savings per patient of 26% over posaconazole and 13% over voriconazole. Monte Carlo simulation demonstrated a mean cost saving with fluconazole of AU$8430 per patient (95% CI AU$5803-AU$11 054) versus posaconazole and AU$3681 per patient (95% CI AU$990-AU$6319) versus voriconazole. One-way sensitivity analyses confirmed the robustness of the model.
  
  
  CONCLUSIONS
  This is the first study to show that, in the setting of consolidation therapy for AML, fluconazole is the most cost-effective approach to antifungal prophylaxis compared with posaconazole or voriconazole.
authors.affiliation: Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, 381 Royal Parade, Parkville, Victoria 3052, Australia.
authors.forename: Siow-Chin
authors.initials: SC
authors.lastname: Heng
authors.forename: Monica A
authors.initials: MA
authors.lastname: Slavin
authors.forename: Daoud
authors.initials: D
authors.lastname: Al-Badriyeh
authors.forename: Sue
authors.initials: S
authors.lastname: Kirsa
authors.forename: John F
authors.initials: JF
authors.lastname: Seymour
authors.forename: Andrew
authors.initials: A
authors.lastname: Grigg
authors.forename: Karin
authors.initials: K
authors.lastname: Thursky
authors.forename: Ashish
authors.initials: A
authors.lastname: Bajel
authors.forename: Roger L
authors.initials: RL
authors.lastname: Nation
authors.forename: David C M
authors.initials: DC
authors.lastname: Kong
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000935:Antifungal Agents / Q000008:administration & dosage / Q000191:economics*; D018890:Chemoprevention / Q000191:economics* / Q000379:methods; D060830:Consolidation Chemotherapy; D017850:Economics, Pharmaceutical; D005260:Female; D015725:Fluconazole / Q000008:administration & dosage / Q000191:economics*; D006801:Humans; D016867:Immunocompromised Host; D015470:Leukemia, Myeloid, Acute / Q000150:complications* / Q000188:drug therapy; D008297:Male; D008875:Middle Aged; D009181:Mycoses / Q000517:prevention & control*; D011743:Pyrimidines / Q000008:administration & dosage / Q000191:economics*; D012189:Retrospective Studies; D016896:Treatment Outcome; D014230:Triazoles / Q000008:administration & dosage / Q000191:economics*; D065819:Voriconazole; D055815:Young Adult
chemical_list: D000935:Antifungal Agents; D011743:Pyrimidines; D014230:Triazoles; C101425:posaconazole; D015725:Fluconazole; D065819:Voriconazole
keywords: AML; antifungals; modelling