title: Posaconazole vs fluconazole or itraconazole for prevention of invasive fungal diseases in patients with acute myeloid leukemia or myelodysplastic syndrome: a cost-effectiveness analysis in an Asian teaching hospital.
abstract: BACKGROUND
  Posaconazole is superior to fluconazole/itraconazole in preventing invasive fungal diseases (IFDs) in neutropenic patients. Whether the higher cost of posaconazole is offset by decreases in IFDs in a given institute requires cost-effective analysis encompassing the spectrum of IFDs and socioeconomic factors specific to that geographic area.
  
  
  METHODS
  This study performed a cost-effective analysis of posaconazole prophylaxis for IFDs in an Asian teaching hospital, employing decision modeling and data of IFDs and medication costs specific to the institute, in neutropenic patients with acute myeloid leukemia (AML) or myelodysplastic syndrome (MDS).
  
  
  RESULTS
  In the cost-effectiveness analysis, the higher cost of posaconazole was partially offset by a reduction in the cost of treating IFDs that were prevented, resulting in an incremental cost of 125,954 Hong Kong dollars/16,148 USD per IFD avoided. Over a lifetime horizon, assuming same case fatality rate of IFDs in both groups, use of posaconazole results in 0.07 discounted life years saved. This corresponds to an incremental cost of 116,023 HKD/14,875 USD per life year saved. This incremental cost per life year saved in posaconazole prophylaxis fulfilled the World Health Organization defined threshold for cost-effectiveness.
  
  
  CONCLUSIONS
  Posaconazole prophylaxis was cost-effective in Hong Kong.
authors.affiliation: a a Division of Haematology and Haematological Oncology , Department of Medicine, Queen Mary Hospital , Hong Kong , PR China.
authors.forename: Thomas S Y
authors.initials: TS
authors.lastname: Chan
authors.affiliation: b b Outcomes Research CORE, Merck & Co. , Kenilworth, NJ , USA.
authors.forename: Stephen W
authors.initials: SW
authors.lastname: Marcella
authors.affiliation: a a Division of Haematology and Haematological Oncology , Department of Medicine, Queen Mary Hospital , Hong Kong , PR China.
authors.forename: Harinder
authors.initials: H
authors.lastname: Gill
authors.affiliation: a a Division of Haematology and Haematological Oncology , Department of Medicine, Queen Mary Hospital , Hong Kong , PR China.
authors.forename: Yu-Yan
authors.initials: YY
authors.lastname: Hwang
authors.affiliation: a a Division of Haematology and Haematological Oncology , Department of Medicine, Queen Mary Hospital , Hong Kong , PR China.
authors.forename: Yok-Lam
authors.initials: YL
authors.lastname: Kwong
mesh_terms: D000935:Antifungal Agents / Q000008:administration & dosage / Q000191:economics*; D003362:Cost-Benefit Analysis; D003661:Decision Support Techniques; D015725:Fluconazole / Q000008:administration & dosage / Q000191:economics*; D006723:Hong Kong; D006784:Hospitals, Teaching; D006801:Humans; D017964:Itraconazole / Q000008:administration & dosage / Q000191:economics*; D015470:Leukemia, Myeloid, Acute / Q000150:complications / Q000401:mortality; D017059:Models, Econometric; D009181:Mycoses / Q000209:etiology / Q000401:mortality / Q000517:prevention & control*; D009190:Myelodysplastic Syndromes / Q000150:complications / Q000401:mortality; D012959:Socioeconomic Factors; D014230:Triazoles / Q000008:administration & dosage / Q000191:economics*
chemical_list: D000935:Antifungal Agents; D014230:Triazoles; D017964:Itraconazole; C101425:posaconazole; D015725:Fluconazole
keywords: Antifungal prophylaxis; Cost-effective; Cost-saving; Fluconazole; Itraconazole; Neutropenia; Posaconazole