Comparative cost-effectiveness analysis of voriconazole and fluconazole for prevention of invasive fungal infection in patients receiving allogeneic hematopoietic cell transplants.
OBJECTIVE
The cost-effectiveness of voriconazole versus fluconazole prophylaxis against fungal infections in hematopoietic cell transplant (HCT) recipients is investigated.


METHODS
A decision-analytic model was developed to estimate the drug costs associated with planned or supplemental prophylaxis and empirical therapy and the costs of treating suspected or documented invasive fungal infections (IFIs) in HCT recipients. Published clinical trial data on 599 patients who received 100-180 days of prophylactic therapy with voriconazole or fluconazole were used to model specified IFI-prevention and mortality outcomes; 6-month, 12-month, and lifetime incremental cost-effectiveness ratios (ICERs) were estimated, with a bootstrap analysis performed to reffect the uncertainty of the clinical trial data.


RESULTS
Estimated mean total prophylaxis and IFI-related costs associated with voriconazole versus fluconazole prophylaxis over 12 months were higher in the entire study population and among patients receiving HCT for diagnoses other than acute myeloid leukemia (AML) but were not significantly different for patients with AML. The cost per IFI avoided ($66,919) and the cost per life-year gained ($5,453) were lower among patients with AML who received voriconazole relative to the full study population. ICERs were more favorable for voriconazole over a 6-month time frame and when modeling was conducted using generic price data. Assuming a threshold value of $50,000 for one year of life gained, the calculated probability of voriconazole being cost-effective was 33% for the full study population and 85% for the AML subgroup.


CONCLUSIONS
The decision model indicated that voriconazole prophylaxis was cost-effective for patients undergoing allogeneic HCT for AML.
Health Economics, RTI Health Solutions, Research Triangle Park, NC 12194, USA. jmauskopf@rti.org
Josephine
J
Mauskopf
Costel
C
Chirila
Jon
J
Graham
Iris D
ID
Gersten
Helen
H
Leather
Richard T
RT
Maziarz
Lindsey R
LR
Baden
Javier
J
Bolaños-Meade
Janice M Y
JM
Brown
Thomas J
TJ
Walsh
Mary H
MH
Horowitz
Joanne
J
Kurtzberg
Kieren A
KA
Marr
John R
JR
Wingard
D000935:Antifungal Agents / Q000191:economics* / Q000627:therapeutic use; D016022:Case-Control Studies; D015331:Cohort Studies; D003362:Cost-Benefit Analysis; D003661:Decision Support Techniques; D004311:Double-Blind Method; D015725:Fluconazole / Q000191:economics* / Q000627:therapeutic use; D005500:Follow-Up Studies; D018380:Hematopoietic Stem Cell Transplantation / Q000191:economics* / Q000379:methods; D006801:Humans; D009181:Mycoses / Q000188:drug therapy / Q000191:economics* / Q000453:epidemiology; D011743:Pyrimidines / Q000191:economics* / Q000627:therapeutic use; D014184:Transplantation, Homologous; D014230:Triazoles / Q000191:economics* / Q000627:therapeutic use; D065819:Voriconazole
D000935:Antifungal Agents; D011743:Pyrimidines; D014230:Triazoles; D015725:Fluconazole; D065819:Voriconazole