title: Pharmacoeconomic evaluation of voriconazole vs. liposomal amphotericin B in empiric treatment of invasive fungal infections in Turkey.
abstract: BACKGROUND
  Invasive fungal infections (IFI) are associated with considerable expense and mortality on healthcare systems. There is a need to provide evidence of both clinical efficacy and value for money with any health technology. The current pharmacoeconomic evaluation investigated the use of liposomal amphotericin B (LAmB) and voriconazole for the empiric treatment of IFI in the Turkish setting.
  
  
  METHODS
  Decision analytic modelling was used to create a pathway for patient treatment with a 5-point composite outcome measure. The data was obtained from a major non-inferiority multicentre randomised controlled study, with an expert panel of clinicians in Turkey providing transition probabilities and cost not available in the literature. Sensitivity analyses were performed on the inputs from the clinical trial and the expert panel.
  
  
  RESULTS
  As per the base case analysis, voriconazole was preferred by Turkish Lira (TL) 2,523 per patient treated and TL2,520 per surviving patient. LAmB was the preferred alternative by TL5,362 per successfully treated patient. Removing fever resolution as part of the composite outcome measure resulted in voriconazole being the preferred alternative per successfully treated patient. Univariate sensitivity analysis highlighted that increasing the duration of voriconazole by >1.2 days or decreasing LAmB by >1.0 days changes the result. Monte Carlo Simulation resulted in 69.4% of simulations favouring voriconazole per patient treated.
  
  
  CONCLUSIONS
  There is a strong likelihood that voriconazole is economically more favourable than LAmB in the empiric treatment of IFI in Turkey.
authors.affiliation: Department of Pediatrics, Pediatric Intensive Care and Pediatric Infectious Disease, Faculty of Medicine, Eskisehir Osmangazi University, Eskisehir 26480, Turkey. timboothtr@yahoo.com.
authors.forename: Stuart J
authors.initials: SJ
authors.lastname: Turner
authors.forename: Esin
authors.initials: E
authors.lastname: Senol
authors.forename: Ates
authors.initials: A
authors.lastname: Kara
authors.forename: Daoud
authors.initials: D
authors.lastname: Al-Badriyeh
authors.forename: Ener C
authors.initials: EC
authors.lastname: Dinleyici
authors.forename: David Cm
authors.initials: DC
authors.lastname: Kong
mesh_terms: D000666:Amphotericin B / Q000191:economics* / Q000627:therapeutic use; D000935:Antifungal Agents / Q000191:economics* / Q000627:therapeutic use; D003362:Cost-Benefit Analysis; D017850:Economics, Pharmaceutical; D006801:Humans; D009181:Mycoses / Q000188:drug therapy* / Q000191:economics*; D011743:Pyrimidines / Q000191:economics* / Q000627:therapeutic use; D016896:Treatment Outcome; D014230:Triazoles / Q000191:economics* / Q000627:therapeutic use; D014421:Turkey; D065819:Voriconazole
chemical_list: D000935:Antifungal Agents; D011743:Pyrimidines; D014230:Triazoles; C068538:liposomal amphotericin B; D000666:Amphotericin B; D065819:Voriconazole