Costo Efectividad de Posaconazol versus Fluconazol/Itraconazol en el Tratamiento Profiláctico de las Infecciones Fúngicas Invasivas en México

Rely, K; Alexandre, Pierre K.; Salinas-Escudero, Guillermo

doi:10.1016/j.jval.2011.05.032

Cited by 5 publications

(3 citation statements)

References 29 publications

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“…In the one-way sensitivity analysis, the incremental cost-effectiveness ratio was more sensitive to changes in the costs of IFD; however, the ICER stayed well below the threshold value of €30,000 (€5615.08/LYG), revealing that routine use of posaconazole oral tablets would be a cost-saving prophylactic alternative when the likelihood of IFD or the cost of treatment medications are expected to be particularly high. This result aligned with other similar conclusions in other health care systems [ 41 ]. Posaconazole tablets would lose their dominance if the cost of the management of IFD goes under the €39,750 used in our analysis of the costs of IFD.…”

Section: Discussionsupporting

confidence: 93%

Cost-Effectiveness of Posaconazole Tablets for Invasive Fungal Infections Prevention in Acute Myelogenous Leukemia or Myelodysplastic Syndrome Patients in Spain

et al. 2017

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IntroductionPosaconazole is superior to fluconazole (FLU) and itraconazole (ITRA) in the prevention of invasive fungal diseases (IFDs) in neutropenic patients with acute myelogenous leukemia (AML) and myelodysplastic syndrome (MDS). A new tablet formulation of posaconazole with improved pharmacokinetic and pharmacodynamic properties compared to posaconazole oral solution has recently been approved. The objective of this study is to estimate the cost-effectiveness of the newly developed posaconazole tablets versus FLU oral suspension or ITRA oral solution for preventing IFDs in high-risk neutropenic patients with AML or MDS and from the perspective of the Spanish National Health System (NHS).MethodsA previously validated economic model was used. The probabilities of experiencing an IFD, an IFD-related death or death from other causes over 100 days were based on clinical trial data and input into a decision tree. Surviving patients were entered into a Markov model to calculate total costs, number of IFDs and number of life-years gained per patient over a lifetime horizon in each disease and treatment group. Two health states, alive and dead, were considered. Health effects were discounted using a rate of 3%. Univariate and probabilistic sensitivity analyses were conducted.ResultsDuring the first 100 days, posaconazole tablets were associated with a lower risk of IFDs (0.046 vs. 0.111), longer life expectancy (2.92 vs. 2.69 years) and lower total costs (€5906.06 vs. €7847.20 per patient) over the patients’ lifetimes compared to FLU or ITRA treatments. Thus, posaconazole tablets were more effective and less costly than FLU or ITRA. Probabilistic sensitivity analysis indicated that there was a 79.9% probability of posaconazole tablets being cost-saving compared to FLU or ITRA.ConclusionFrom the Spanish NHS perspective, posaconazole tablets are cost-effective compared to FLU or ITRA in AML or MSD patients with chemotherapy-induced neutropenia and at high risk for IFDs.FundingMSD Sharp & Dohme.

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Section: Discussionsupporting

confidence: 93%

Cost-Effectiveness of Posaconazole Tablets for Invasive Fungal Infections Prevention in Acute Myelogenous Leukemia or Myelodysplastic Syndrome Patients in Spain

et al. 2017

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“…Six economic evaluations of posaconazole were performed using data from a clinical trial of prophylaxis up to 84 days in patients receiving intense chemotherapy for hematological malignancies with clinical endpoints determined at 100 days compared with itraconazole or fluconazole. 13,19,20,21,22,23 The results of these studies all showed that posaconazole was cost saving and was associated with longer life expectancy than standard therapy with either itraconazole or fluconazole. A cost-effectiveness analysis comparing voriconazole with posaconazole prophylaxis, in those undergoing induction with chemotherapy for AML using observational data of a switch from use of voriconazole to posaconazole in a single hospital, showed cost saving and greater therapeutic success with posaconazole.…”

Section: Discussionmentioning

confidence: 97%

“…When the time horizon for the analysis presented in this article was shortened to 6 months, which is similar to the time horizons used in most previously published cost-effectiveness analyses for antifungal prophylaxis with posaconazole, micafungin, or voriconazole in patients with hematological malignancies, 13,19,20,21,22,23,24,26,27 the cost-effectiveness ratios were more favorable for voriconazole because the observed reduction in IFIs was greater between zero and 6 months than between zero and 12 months. In particular, for the AML subpopulation, the cost per IFI avoided was $34,576 at 6 months compared with $66,919 at 12 months.…”

Section: Discussionmentioning

confidence: 99%

Comparative cost-effectiveness analysis of voriconazole and fluconazole for prevention of invasive fungal infection in patients receiving allogeneic hematopoietic cell transplants

Mauskopf

Chirila

Graham

et al. 2013

American Journal of Health-System Pharmacy

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Purpose Cost-effectiveness analysis of voriconazole compared with fluconazole, both with galactomannan monitoring, for prevention of invasive fungal infections (IFI) in patients receiving allogeneic hematopoietic cell transplantation (HCT) Methods A decision analytic economic model was developed to estimate the drug costs associated with planned prophylaxis, supplemental prophylaxis, and empirical therapy and costs associated with treatment of suspected or documented IFI. We estimated incremental cost-effectiveness ratios (ICERs) at 6 months, 12 months, and lifetime. A bootstrap analysis was conducted to estimate the uncertainty of the clinical trial results. Results At 12 months, mean total fungal-infection-related costs were not significantly different for voriconazole prophylaxis than for fluconazole prophylaxis for a subpopulation with acute myeloid leukemia (AML) but were significantly higher for voriconazole prophylaxis for the study population and in a subpopulation of those with other underlying diseases. The cost per IFI avoided ($66,919) and the cost per life-year gained (LYG) ($5,453) were also lower for the AML subgroup than for the complete trial population ($812,990/IFI avoided; and dominated for cost/LYG). ICERs were more favorable for voriconazole at 6 months and when the generic price was used for oral voriconazole. Bootstrap analysis results for the cost per LYG showed that the probability of voriconazole being cost-effective is 33% for the complete study population and 85% for the AML subpopulation, for a maximum willingness to pay for 1 year of life gained of $50,000. Conclusion Voriconazole prophylaxis was significantly more costly than fluconazole for the complete study population but may be cost-effective for those undergoing an allogeneic HCT for AML. Use of generic oral voriconazole will have a favorable impact on the costs and cost-effectiveness of prophylaxis with voriconazole compared with fluconazole for all undergoing allogeneic HCT.

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High incidence of invasive fungal infection during acute myeloid leukemia treatment in a resource-limited country: clinical risk factors and treatment outcomes

Nganthavee

Phutthasakda

Atipas

et al. 2019

Support Care Cancer

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Costo Efectividad de Posaconazol versus Fluconazol/Itraconazol en el Tratamiento Profiláctico de las Infecciones Fúngicas Invasivas en México

Abstract: Posaconazole provides modest incremental benefits compared with standard azole therapy in the prophylaxis against IFIs among high-risk neutropenic patients. Routine Posaconazole use appears a cost saving when the likelihood of IFIs or the cost of treatment medications is high.

Cited by 5 publications

References 29 publications

Cost-Effectiveness of Posaconazole Tablets for Invasive Fungal Infections Prevention in Acute Myelogenous Leukemia or Myelodysplastic Syndrome Patients in Spain

Cost-Effectiveness of Posaconazole Tablets for Invasive Fungal Infections Prevention in Acute Myelogenous Leukemia or Myelodysplastic Syndrome Patients in Spain

Comparative cost-effectiveness analysis of voriconazole and fluconazole for prevention of invasive fungal infection in patients receiving allogeneic hematopoietic cell transplants

High incidence of invasive fungal infection during acute myeloid leukemia treatment in a resource-limited country: clinical risk factors and treatment outcomes

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