Cost Analysis of the Use of Voriconazole, Posaconazole and Micafungin in the Primary Prophylaxis of Invasive Fungal Infections in Recipients of Allogeneic Hematopoietic Stem Cell Transplants.

Santiago Grau,Carlos Rubio-Terrés,Carlos Solano,Irene Rodríguez,Darío Rubio-Rodríguez,Isidro Jarque,Jon A Barrueta,Carmen Peral,Carol García-Vidal

doi:10.36469/9832

Abstract

Objectives: Compare the cost of the primary prophylaxis of invasive fungal infections (IFI) with voriconazole, posaconazole, and micafungin in patients undergoing allogeneic hematopoietic stem cell transplantation (HSCT) in hospitals of the National Health System (NHS) in Spain.Methods: A cost analysis was made for 100 days and 180 days of prophylaxis and a decision tree model was developed. The efficacy rate of IFI prophylaxis and survival rate with liposomal amphotericin B treatment of prophylaxis failures were obtained from randomized trials and a meta-analysis of mixed treatment comparisons. The model simulation was interrupted with IFI treatment (prophylaxis failures). The costs of medication and its intravenous administration in the hospital (in the case of micafungin) were considered.Results: In the non-modeled analysis, the savings per patient of prophylaxis with voriconazole ranged from €1,709 to €9,655 compared with posaconazole oral solution, from €1,811 to €9,767 compared with posaconazole gastro-resistant tablets and from €3,376 to €7,713 compared with micafungin. In the modeled analysis, the mean cost per patient of the prophylaxis and treatment of IFIs was €6,987 to €7,619 with voriconazole, €7,749 with posaconazole, and €22,424 with micafungin. Therefore, the savings per patient of prophylaxis with voriconazole was €130 to €3,664 and €11,132 to €30,374 compared with posaconazole and micafungin, respectively. The result remained stable after modification of the number of days of antifungal prophylaxis and the cost of antifungal treatment of failures.Conclusion: Taking into account this model, antifungal prophylaxis with voriconazole in recipients of hematopoietic progenitor transplants, compared with posaconazole or micafungin, may represent savings for hospitals in Spain.

Highlights

Invasive fungal infections (IFI) by yeasts and filamentous fungi are a persistent problem in Spain.[1]
The cost per patient of prophylaxis was assessed, taking into account the following variables: purchase exfactory price of the drugs[8], a treatment period of 100 days, or 180 days in the case of high risk patients[9], and, patient body weight, which determines the daily dose of voriconazole and micafungin
For 100 days of prophylaxis, the savings per patient treated with voriconazole compared with oral solution of posaconazole ranged from €1,709 to €5,348, depending on the scenario analyzed

Summary

Introduction

Invasive fungal infections (IFI) by yeasts and filamentous fungi are a persistent problem in Spain.[1] The widespread use of prophylactic fluconazole has resulted in a dramatic decline in the frequency of IFIs. IFIs due to filamentous fungi in general and invasive aspergillosis in particular continue to be a major health problem, especially in patients with acute leukemia and high-risk myelodysplastic syndromes, and in patients who have received allogeneic hematopoietic stem cell transplants (HSCT).[1,2] The incidence of proven or probable IFI due to filamentous fungi in hematological patients at risk ranges from 4% to 22%, in most cases involving invasive aspergillosis.[1] In addition, in hematology patients at risk the mean rate of mortality associated with invasive candidiasis is greater than 30% and that associated with invasive aspergillosis is greater than 50%.1,3-5. The cost of an episode of IFI in Spain has been estimated at €14,293. Out of this amount, 68% is due to the hospital stay and the remaining 32% is due mainly to the antifungal treatment.[6]

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