title: Cost-benefit Analysis of Posaconazole Versus Fluconazole or Itraconazole as a Primary Antifungal Prophylaxis in High-risk Hematologic Patients: A Propensity Score-matched Analysis.
abstract: OBJECTIVE
  Posaconazole is effective for the prophylaxis of invasive fungal infections (IFIs) in patients with acute myeloid leukemia or myelodysplastic syndrome during remission induction chemotherapy. However, a cost-benefit analysis of posaconazole versus fluconazole or itraconazole has not been conducted in Korea.
  
  
  METHODS
  We retrospectively reviewed data for all consecutive patients who received primary antifungal prophylaxis during remission induction chemotherapy in our acute myeloid leukemia/myelodysplastic syndrome cohort from December 2010 to November 2013. Patient characteristics and factors known as a risk of IFI were matched with propensity score analysis. We evaluated the medical cost according to the prophylactic antifungal agents (posaconazole vs fluconazole/itraconazole), the development of breakthrough IFIs, and survival status after propensity score matching in a 1:1 ratio.
  
  
  RESULTS
  Of the 419 baseline patients, 100 patients in each group were analyzed after matching. A significant decrease was found in the development of breakthrough proven or probable IFIs (3.0% vs 14.0%; P = 0.009) and the rate of empirical antifungal therapy (EAFT) (12.0% vs 46.0%; P < 0.001) in the posaconazole group. Total in-hospital medical costs per patient were not statistically different between posaconazole and fluconazole/itraconazole prophylaxis. However, the daily medical cost was lower for posaconazole prophylaxis, resulting in a total daily cost savings of $72 (₩79,458) per patient (P = 0.002). In the cases of breakthrough proven/probable IFIs, EAFT, and in-hospital deaths, the total medical costs per patient were significantly higher than in nonproven/probable IFIs, non-EAFT, and in-hospital survivors, as much as $7,916 (₩8,700,758), $4605 (₩5,062,529), and $11,134 (₩12,238,422), respectively. Costs for the antifungal agent used in targeted or empirical therapy were lower in the posaconazole group, resulting in a savings of $697 (₩766,347) per patient (P < 0.001).
  
  
  CONCLUSIONS
  Posaconazole appears to be cost beneficial for primary antifungal prophylaxis in high-risk patients with hematologic malignancy, at a single center, in Korea. Cost-benefit is closely related with clinical outcomes, including breakthrough IFI development, EAFT, and survival status.
authors.affiliation: Division of Infectious Diseases, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea; Vaccine Bio Research Institute, The Catholic University of Korea, Seoul, Republic of Korea.
authors.forename: Sung-Yeon
authors.initials: SY
authors.lastname: Cho
authors.affiliation: Division of Infectious Diseases, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea; Vaccine Bio Research Institute, The Catholic University of Korea, Seoul, Republic of Korea; The Catholic Blood and Marrow Transplantation Center, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea. Electronic address: symonlee@catholic.ac.kr.
authors.forename: Dong-Gun
authors.initials: DG
authors.lastname: Lee
authors.affiliation: Division of Infectious Diseases, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea; Vaccine Bio Research Institute, The Catholic University of Korea, Seoul, Republic of Korea.
authors.forename: Jae-Ki
authors.initials: JK
authors.lastname: Choi
authors.affiliation: Division of Infectious Diseases, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea; Vaccine Bio Research Institute, The Catholic University of Korea, Seoul, Republic of Korea.
authors.forename: Hyo-Jin
authors.initials: HJ
authors.lastname: Lee
authors.affiliation: Division of Infectious Diseases, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea; Vaccine Bio Research Institute, The Catholic University of Korea, Seoul, Republic of Korea.
authors.forename: Si-Hyun
authors.initials: SH
authors.lastname: Kim
authors.affiliation: Division of Infectious Diseases, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea; Vaccine Bio Research Institute, The Catholic University of Korea, Seoul, Republic of Korea.
authors.forename: Sun-Hee
authors.initials: SH
authors.lastname: Park
authors.affiliation: Division of Infectious Diseases, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea; Vaccine Bio Research Institute, The Catholic University of Korea, Seoul, Republic of Korea.
authors.forename: Su-Mi
authors.initials: SM
authors.lastname: Choi
authors.affiliation: Division of Infectious Diseases, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea; Vaccine Bio Research Institute, The Catholic University of Korea, Seoul, Republic of Korea.
authors.forename: Jung-Hyun
authors.initials: JH
authors.lastname: Choi
authors.affiliation: Division of Infectious Diseases, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea; Vaccine Bio Research Institute, The Catholic University of Korea, Seoul, Republic of Korea.
authors.forename: Jin-Hong
authors.initials: JH
authors.lastname: Yoo
authors.affiliation: The Catholic Blood and Marrow Transplantation Center, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
authors.forename: Yoo-Jin
authors.initials: YJ
authors.lastname: Kim
authors.affiliation: The Catholic Blood and Marrow Transplantation Center, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
authors.forename: Hee-Je
authors.initials: HJ
authors.lastname: Kim
authors.affiliation: The Catholic Blood and Marrow Transplantation Center, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
authors.forename: Woo-Sung
authors.initials: WS
authors.lastname: Min
authors.affiliation: Market Access, Merck Sharp & Dohme, Seoul, Republic of Korea.
authors.forename: Heejung
authors.initials: H
authors.lastname: Back
authors.affiliation: Market Access, Merck Sharp & Dohme, Seoul, Republic of Korea; Pharmaceutical Policy & Outcomes Research, School of Pharmacy, Sungkyunkwan University, Seoul, Republic of Korea.
authors.forename: Sukhyun
authors.initials: S
authors.lastname: Kang
authors.affiliation: Pharmaceutical Policy & Outcomes Research, School of Pharmacy, Sungkyunkwan University, Seoul, Republic of Korea.
authors.forename: Eui-Kyung
authors.initials: EK
authors.lastname: Lee
mesh_terms: D000328:Adult; D019072:Antibiotic Prophylaxis / Q000191:economics*; D000935:Antifungal Agents / Q000191:economics / Q000627:therapeutic use*; D000970:Antineoplastic Agents / Q000009:adverse effects; D017046:Cost Savings / Q000191:economics; D003362:Cost-Benefit Analysis; D016527:Drug Costs; D005260:Female; D015725:Fluconazole / Q000191:economics / Q000627:therapeutic use*; D017721:Hospital Costs; D006801:Humans; D017964:Itraconazole / Q000191:economics / Q000627:therapeutic use*; D015470:Leukemia, Myeloid, Acute / Q000188:drug therapy; D008297:Male; D008875:Middle Aged; D009181:Mycoses / Q000139:chemically induced / Q000517:prevention & control*; D011322:Primary Prevention / Q000191:economics; D057216:Propensity Score; D012074:Remission Induction; D056910:Republic of Korea; D012189:Retrospective Studies; D014230:Triazoles / Q000191:economics / Q000627:therapeutic use*
chemical_list: D000935:Antifungal Agents; D000970:Antineoplastic Agents; D014230:Triazoles; D017964:Itraconazole; C101425:posaconazole; D015725:Fluconazole
keywords: acute myeloid leukemia; antibiotic prophylaxis; cost–benefit analysis; myelodysplastic syndromes; posaconazole