title: Cost-effectiveness of primary antifungal prophylaxis with posaconazole versus itraconazole in allogeneic hematopoietic stem cell transplantation.
abstract: OBJECTIVE
  To evaluate the cost-effectiveness of posaconazole vs itraconazole in the prevention of invasive fungal infections (IFIs) in recipients of allogeneic hematopoietic stem cell transplantation (allo-HSCT).
  
  
  METHODS
  Total hospital-based costs from initial admission for allo-HSCT until day 100 after transplantation were evaluated for 49 patients in whom the clinical efficacy of antifungal prophylaxis with posaconazole vs itraconazole had been previously analyzed and reported. Clinical and economic data were used to determine the incremental costs per IFI avoided and per life-year gained for posaconazole compared with itraconazole. Confidence intervals for the incremental cost-effectiveness ratio (ICER) and a cost-effectiveness acceptability curve were estimated through bootstrapping with the bias-corrected percentile method.
  
  
  RESULTS
  According to our analysis, the total cost of allo-HSCT per patient during the 100-day fixed-treatment period was €46,562 in the posaconazole group (n = 33) and €45,080 in the itraconazole group (n = 16). However, the reduction in the incidence of IFI and the improved outcome with posaconazole resulted in a favorable ICER of €11,856 per IFI avoided and €5218 per life-year gained. With the outcomes of the bootstrap procedure, the cost-effectiveness acceptability curve was constructed. Assuming a threshold of €30,000 per life-year gained, the ICER based on life-years gained is acceptable with 75% certainty.
  
  
  CONCLUSIONS
  This evaluation is based on data from a single-center, non-randomized study. Preference weights or utilities were not available to calculate quality-adjusted life-years. Extra-mural costs were only partially evaluated from a hospital perspective. Indirect costs and economic consequences are not included.
  
  
  CONCLUSIONS
  This economic evaluation compared direct medical costs associated with posaconazole or itraconazole treatment; the data suggest that posaconazole may be cost-effective as antifungal prophylaxis during the early high-risk neutropenic period and up to 100 days after allo-HSCT.
authors.affiliation: Department of Hematology, Catalan Institute of Oncology, Hospital Duran i Reynals, Barcelona, Spain.
authors.forename: Isabel
authors.initials: I
authors.lastname: Sánchez-Ortega
authors.forename: Beatriz
authors.initials: B
authors.lastname: Patiño
authors.forename: Carmen
authors.initials: C
authors.lastname: Muñoz
authors.forename: Montserrat
authors.initials: M
authors.lastname: Arnan
authors.forename: Teresa
authors.initials: T
authors.lastname: Peralta
authors.forename: Ana
authors.initials: A
authors.lastname: Clopés
authors.forename: Alberto Fernández
authors.initials: AF
authors.lastname: de Sevilla
authors.forename: Rafael F
authors.initials: RF
authors.lastname: Duarte
mesh_terms: D000935:Antifungal Agents / Q000191:economics* / Q000627:therapeutic use; D002173:Cancer Care Facilities; D016001:Confidence Intervals; D003362:Cost-Benefit Analysis / Q000706:statistics & numerical data; D015725:Fluconazole / Q000191:economics* / Q000627:therapeutic use; D006295:Health Resources / Q000706:statistics & numerical data; D018380:Hematopoietic Stem Cell Transplantation / Q000191:economics*; D006801:Humans; D017964:Itraconazole / Q000191:economics* / Q000627:therapeutic use; D064887:Observational Studies as Topic; D013030:Spain; D014230:Triazoles / Q000191:economics* / Q000627:therapeutic use
chemical_list: D000935:Antifungal Agents; D014230:Triazoles; D017964:Itraconazole; C101425:posaconazole; D015725:Fluconazole