title: Economic evaluation of posaconazole versus fluconazole or itraconazole in the prevention of invasive fungal infection in high-risk neutropenic patients in Sweden.
abstract: BACKGROUND
  In patients undergoing induction chemotherapy for acute myeloid leukemia (AML) or myelodysplastic syndromes (MDS), posaconazole has been proven more effective in the prevention of invasive fungal infection (IFI) than fluconazole or itraconazole (standard azoles) The current analysis seeks to estimate the cost effectiveness of prophylactic posaconazole compared with standard azoles in AML or MDS patients with severe chemotherapy-induced neutropenia in Sweden.
  
  
  METHODS
  A decision-analytic model was used to estimate life expectancy, costs, and quality-adjusted life-years (QALYs). Efficacy data were derived from a phase III clinical trial. Life expectancy and quality of life data were collected from the literature. A modified Delphi method was used to gather expert opinion on resource use for an IFI. Unit costs were captured from hospital and pharmacy pricelists. A probabilistic sensitivity analysis (PSA) was used to investigate the impact of uncertainty in the model parameters on the cost-effectiveness results.
  
  
  RESULTS
  The estimated mean direct cost per patient with posaconazole prophylaxis was 46,893 Swedish kronor (SEK) (€5,387) and SEK50,017 (€5,746) with standard azoles. Prophylaxis with posaconazole resulted in 0.075 QALYs gained compared with standard azoles. At a cost-effectiveness threshold of SEK500,000/QALY the PSA demonstrated a more than 95 % probability that posaconazole is cost effective versus standard azoles for the prevention of IFI in high-risk neutropenic patients in Sweden.
  
  
  CONCLUSIONS
  Given the assumptions, methods, and data used, posaconazole is expected to be cost effective compared with standard azoles when used as antifungal prophylaxis in AML or MDS patients with chemotherapy-induced prolonged neutropenia in Sweden.
authors.affiliation: Outcomes Research, MSD Sweden (AB), Rotebersvagen 3, 19207, Sollentuna, Sweden, j_lundberg@mail.com.
authors.forename: Johan
authors.initials: J
authors.lastname: Lundberg
authors.forename: Martin
authors.initials: M
authors.lastname: Höglund
authors.forename: Magnus
authors.initials: M
authors.lastname: Björkholm
authors.forename: Örjan
authors.initials: Ö
authors.lastname: Åkerborg
mesh_terms: D000368:Aged; D000935:Antifungal Agents / Q000191:economics* / Q000627:therapeutic use*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects; D017326:Clinical Trials, Phase III as Topic; D003362:Cost-Benefit Analysis; D005260:Female; D015725:Fluconazole / Q000008:administration & dosage / Q000191:economics / Q000627:therapeutic use*; D006801:Humans; D017964:Itraconazole / Q000008:administration & dosage / Q000191:economics / Q000627:therapeutic use*; D015470:Leukemia, Myeloid, Acute / Q000150:complications / Q000188:drug therapy / Q000382:microbiology; D008017:Life Expectancy; D008297:Male; D008875:Middle Aged; D009181:Mycoses / Q000150:complications* / Q000188:drug therapy / Q000382:microbiology / Q000517:prevention & control*; D009190:Myelodysplastic Syndromes / Q000150:complications / Q000188:drug therapy / Q000382:microbiology; D009503:Neutropenia / Q000139:chemically induced / Q000150:complications* / Q000382:microbiology; D011788:Quality of Life; D019057:Quality-Adjusted Life Years; D013548:Sweden; D014230:Triazoles / Q000008:administration & dosage / Q000191:economics / Q000627:therapeutic use*
chemical_list: D000935:Antifungal Agents; D014230:Triazoles; D017964:Itraconazole; C101425:posaconazole; D015725:Fluconazole