title: Economic evaluation of azoles as primary prophylaxis for the prevention of invasive fungal infections in Spanish patients undergoing allogeneic haematopoietic stem cell transplant.
abstract: Patients undergoing allogeneic haematopoietic stem cell transplantation (alloHSCT) are at risk of developing invasive fungal infections (IFIs). Even with introduction of oral triazole antifungal agents (fluconazole, itraconazole, posaconazole and voriconazole) IFI-associated morbidity and mortality rates and economic burden remain high. Despite their proven efficacy, it is currently unknown which is the most cost-effective antifungal prophylaxis (AFP) agent. To determine the costs and outcomes associated with AFP, a decision-analytic model was used to simulate treatment in a hypothetical cohort of 1000 patients undergoing alloHSCT from the perspective of the Spanish National Health System. Generic itraconazole was the least costly AFP (€162) relative to fluconazole (€500), posaconazole oral suspension (€8628) or voriconazole (€6850). Compared with posaconazole, voriconazole was associated with the lowest number of breakthrough IFIs (36 vs 60); thus, the model predicted fewer deaths from breakthrough IFI for voriconazole (24) than posaconazole (33), and the lowest predicted costs associated with other licensed antifungal treatment and IFI treatment in a cohort of 1000. Voriconazole resulted in cost savings of €4707 per patient compared with posaconazole. Itraconazole demonstrated a high probability of being cost-effective. As primary AFP in alloHSCT patients 180 days posttransplant, voriconazole was more likely to be cost-effective than posaconazole regarding cost per additional IFI and additional death avoided.
authors: Hospital Clínico, INCLIVA-University of Valencia, Valencia, Spain.
authors: Carlos
authors: http://orcid.org/0000-0003-3702-0817
authors: C
authors: Solano
authors: Royal Melbourne Hospital, Melbourne, VIC, Australia.
authors: Monica
authors: M
authors: Slavin
authors: Evidera, Bethesda, MD, USA.
authors: Alissa J
authors: AJ
authors: Shaul
authors: University Hospitals Bristol NHS Foundation Trust, Bristol, UK.
authors: David I
authors: DI
authors: Marks
authors: Hôpital Henri Mondor, Assistance Publique-Hopitaux de Paris and UPEC, Creteil, France.
authors: Catherine
authors: C
authors: Cordonnier
authors: Department I of Internal Medicine, Clinical Trials Centre Cologne, Centre for Integrated Oncology Köln Bonn, Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases, German Centre for Infection Research, University of Cologne, Cologne, Germany.
authors: Oliver A
authors: OA
authors: Cornely
authors: King's College Hospital, London, UK.
authors: Antonio
authors: A
authors: Pagliuca
authors: Evidera, Bethesda, MD, USA.
authors: Lael
authors: L
authors: Cragin
authors: Hospital Universitari i Politècnic La Fe, Valencia, Spain.
authors: Isidro
authors: I
authors: Jarque
authors: Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain.
authors: Carolina
authors: C
authors: Garcia-Vidal
authors: Evidera, Bethesda, MD, USA.
authors: Sonja
authors: S
authors: Sorensen
authors: University of Wisconsin and Visiting Scientist at Evidera, Madison, WI, USA.
authors: David J
authors: DJ
authors: Vanness
authors: Pfizer Inc, Paris, France.
authors: Claudie
authors: C
authors: Charbonneau
authors: Pfizer Inc, Madrid, Spain.
authors: Jon Andoni
authors: JA
authors: Barrueta
authors: Pfizer Inc, Madrid, Spain.
authors: Carmen
authors: C
authors: Peral
authors: Pfizer Inc, Madrid, Spain.
authors: Marina
authors: M
authors: De Salas-Cansado
authors: CancerCare Manitoba, University of Manitoba, Winnipeg, MB, Canada.
authors: Eric J
authors: EJ
authors: Bow
mesh_terms: D000328:Adult; D000935:Antifungal Agents / Q000191:economics* / Q000627:therapeutic use; D003362:Cost-Benefit Analysis; D003661:Decision Support Techniques; D015725:Fluconazole / Q000191:economics / Q000627:therapeutic use; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D000072742:Invasive Fungal Infections / Q000191:economics / Q000208:ethnology / Q000382:microbiology / Q000517:prevention & control*; D017964:Itraconazole / Q000191:economics / Q000627:therapeutic use; D013030:Spain; D014230:Triazoles / Q000191:economics / Q000627:therapeutic use; D065819:Voriconazole / Q000627:therapeutic use
chemical_list: D000935:Antifungal Agents; D014230:Triazoles; D017964:Itraconazole; C101425:posaconazole; D015725:Fluconazole; D065819:Voriconazole
keywords: antifungal prophylaxis; azoles; cost-effectiveness; invasive fungal infections; pharmacoeconomics