title: Cost-effectiveness analysis of combination antifungal therapy with voriconazole and anidulafungin versus voriconazole monotherapy for primary treatment of invasive aspergillosis in Spain.
abstract: OBJECTIVE
  According to a recent randomized, double-blind clinical trial comparing the combination of voriconazole and anidulafungin (VOR+ANI) with VOR monotherapy for invasive aspergillosis (IA) in patients with hematologic disease or with hematopoietic stem cell transplant, mortality was lower after 6 weeks with VOR+ANI than with VOR monotherapy in a post hoc analysis of patients with galactomannan-based IA. The objective of this study was to compare the cost-effectiveness of VOR+ANI with VOR, from the perspective of hospitals in the Spanish National Health System.
  
  
  METHODS
  An economic model with deterministic and probabilistic analyses was used to determine costs per life-year gained (LYG) for VOR+ANI versus VOR in patients with galactomannan-based IA. Mortality, adverse event rates, and life expectancy were obtained from clinical trial data. The costs (in 2015 euros [€]) of the drugs and the adverse event-related costs were obtained from Spanish sources. A Tornado plot and a Monte Carlo simulation (1,000 iterations) were used to assess uncertainty of all model variables.
  
  
  RESULTS
  According to the deterministic analysis, for each patient treated with VOR+ANI compared with VOR monotherapy, there would be a total of 0.348 LYG (2.529 vs 2.181 years, respectively) at an incremental cost of €5,493 (€17,902 vs €12,409, respectively). Consequently, the additional cost per LYG with VOR+ANI compared with VOR would be €15,785. Deterministic sensitivity analyses confirmed the robustness of these findings. In the probabilistic analysis, the cost per LYG with VOR+ANI was €15,774 (95% confidence interval: €15,763-16,692). The probability of VOR+ANI being cost-effective compared with VOR was estimated at 82.5% and 91.9%, based on local cost-effectiveness thresholds of €30,000 and €45,000, respectively.
  
  
  CONCLUSIONS
  According to the present economic study, combination therapy with VOR+ANI is cost-effective as primary therapy of IA in galactomannan-positive patients in Spain who have hematologic disease or hematopoietic stem cell transplant, compared with VOR monotherapy.
authors.affiliation: Pharmacy Department, Hospital del Mar, Universitat Autònoma de Barcelona, Barcelona.
authors.forename: Santiago
authors.initials: S
authors.lastname: Grau
authors.affiliation: Clinical Pharmacology Department, Clínica Universidad de Navarra, Pamplona.
authors.forename: Jose Ramon
authors.initials: JR
authors.lastname: Azanza
authors.affiliation: Infectious Diseases Department, Hospital Universitari Vall d'Hebron, Barcelona.
authors.forename: Isabel
authors.initials: I
authors.lastname: Ruiz
authors.affiliation: Hematology Department, Hospital Universitario Donostia, San Sebastián.
authors.forename: Carlos
authors.initials: C
authors.lastname: Vallejo
authors.affiliation: Infectious Diseases Department, Hospital Clínic de Barcelona, Barcelona, Spain.
authors.forename: Josep
authors.initials: J
authors.lastname: Mensa
authors.affiliation: Hematology Department, University Hospital Gasthuisberg, Leuven, Belgium.
authors.forename: Johan
authors.initials: J
authors.lastname: Maertens
authors.affiliation: Hematology/Oncology Department, Medizinische Klinik und Poliklinik II, Universitätsklinikum, Würzburg, Germany.
authors.forename: Werner J
authors.initials: WJ
authors.lastname: Heinz
authors.affiliation: Medical Department.
authors.forename: Jon Andoni
authors.initials: JA
authors.lastname: Barrueta
authors.affiliation: Economics and Outcomes Research Department, Pfizer S.L.U, Alcobendas.
authors.forename: Carmen
authors.initials: C
authors.lastname: Peral
authors.affiliation: Medical Department.
authors.forename: Francisco Jesús
authors.initials: FJ
authors.lastname: Mesa
authors.affiliation: Clinical Trials Department, Trial Form Support, Madrid, Spain.
authors.forename: Miguel
authors.initials: M
authors.lastname: Barrado
authors.affiliation: Pharmacoeconomics Department, Pfizer International Operations, Paris, France.
authors.forename: Claudie
authors.initials: C
authors.lastname: Charbonneau
authors.affiliation: Pharmacoeconomics Department, Health Value, Madrid, Spain.
authors.forename: Darío
authors.initials: D
authors.lastname: Rubio-Rodríguez
authors.affiliation: Pharmacoeconomics Department, Health Value, Madrid, Spain.
authors.forename: Carlos
authors.initials: C
authors.lastname: Rubio-Terrés
keywords: anidulafungin; cost-effectiveness; galactomannan; invasive aspergillosis; voriconazole