PIN59 A Cost-Effectiveness Analysis of Voriconazol, Anfotericine B and Caspofungin for Invasive Aspergilosis Patients in Panama

Abstract

public databases information and clinical expert panel. The target population was a birth cohort in São Paulo followed for 5 years (598,474). The vaccination coverage rate was 90%, considering a four-dose schedule for 10-valent and tree-dose schedule for PCV13 as suggested by international guides. São Paulo costs and disease data was obtained from national official databases. A mandatory discounted price to the government, calculated by the ex-factory price minus 24.38% was considered to PCV13 and 10-valent. Costs and benefits were discounted at 5% annually. Outcomes were expressed as life years gained(LYG), deaths and number of disease cases avoided. Only the direct effect of vaccination and direct medical costs were considered. RESULTS: The analysis showed higher clinical benefits and lower costs for PCV13 prophylaxis; reduction of 7 deaths, 488 LYG and 17 cases of disease (sepsis and meningitis) and savings of BRL70,097,844(USD43,909,950) in 5 years. The total costs with events and vaccines were BRL113,902,160(USD72,576,883) and BRL137,914,893(USD87,877,465), respectively, for PCV13; and BRL113,999,789(USD71,410,542) and BRL207,915,109(USD130,239,983) for 10-valent. CONCLUSIONS: This study demonstrated that incorporating PCV13 in pediatric immunization routine results in reduction on mortality and morbidity with lower expected cost for São Paulo state healthcare system, showing the dominance of PCV13 regarding 10-valent. PIN59OBJECTIVES: Invasive aspergilosis (IA) is a mycotic disease produce by Aspergillus sp and represents the second leading cause of invasive fungal infections. The mortality rate is about 50%. The aim of this study was to assess the cost-effectiveness (CE) of voriconazol, anfotericine B and caspofungin as first line treatments for IA adult patients in Panama, from the healthcare payer's perspective. METHODS: A decision-tree model was used to compare costs and effectiveness of anfotericine B (comparator), caspofungin and voriconazol for a cohort of patients with IA. Effectiveness measures were: clinical success rates, mortality rates, intensive care unit (ICU) length of stay (LOS), hospital ward LOS and overall costs. Effectiveness and epidemiologic data were collected from published literature. Local costs (2011 US$) were obtained from Panama=s Social Security and Hospital Oncológico Nacional official databases. The model used a 12-week time horizon and only direct medical costs were considered. Monte Carlo probabilistic sensitivity analysis (PSA) was constructed. RESULTS: Results showed voriconazol as the most effective and least expensive option for IA. Clinical success rate was higher with voriconazol (56.6%) compared with anfotericine B (36.4%) and caspofungin (34.2%). Mortality rates were: 34.1% with voriconazol, 50.9% with anfotericine B and 44.7% with caspofungin. Average ICU LOSs was 7.59 days with voriconazol and 9.94 and 9.81 days with anfotericine B and caspofungin, respectively. Voriconazol also obtained the shortest ward LOS (15.96 days). Overall medical costs were $13,100 with...