Cost analysis of voriconazole versus liposomal amphotericin B for primary therapy of invasive aspergillosis among patients with haematological disorders in Germany and Spain.

Xin Gao,Mei Xue,Marina De Salas-Cansado,Isidro Jarque,Carlos Solano,Carolina Garcia-Vidal,Jennifer Stephens,Bertram Weber,Helmut Ostermann,Jon Andoni Barrueta,Claudie Charbonneau

doi:10.1186/2050-6511-15-52

Abstract

BackgroundThe current healthcare climate demands pharmacoeconomic evaluations for different treatment strategies incorporating drug acquisition costs, costs incurred for hospitalisation, drug administration and preparation, diagnostic and laboratory testing and drug-related adverse events (AEs). Here we evaluate the pharmacoeconomics of voriconazole versus liposomal amphotericin B as first-line therapies for invasive aspergillosis (IA) in patients with haematological malignancy and prolonged neutropenia or who were undergoing haematopoietic stem-cell transplantation in Germany or Spain.MethodsA decision analytic model based on a decision tree was constructed to estimate the potential treatment costs of voriconazole versus liposomal amphotericin B. Each model pathway was defined by the probability of an event occurring and the costs of clinical outcomes. Outcome probabilities and cost inputs were derived from the published literature, clinical trials, expert panels and local database costs. In the base case, patients who failed to respond to first-line therapy were assumed to experience a single switch between comparator drugs or the other drug was added as second-line treatment. Base-case evaluation included only drug-management costs and additional hospitalisation costs due to severe AEs associated with first- and second-line therapies. Sensitivity analyses were conducted to assess the robustness of the results. Cost estimates were inflated to 2011 euros (€).ResultsBased on clinical trial success rates of 52.8% (voriconazole) and 50.0% (liposomal amphotericin B), voriconazole had lower total treatment costs compared with liposomal amphotericin B in both Germany (€12,256 versus €18,133; length of therapy [LOT] = 10-day intravenous [IV] + 5-day oral voriconazole and 15-day IV liposomal amphotericin B) and Spain (€8,032 versus €10,516; LOT = 7-day IV + 8-day oral voriconazole and 15-day IV liposomal amphotericin B). Assuming the same efficacy (50.0%) in first-line therapy, voriconazole maintained a lower total treatment cost compared with liposomal amphotericin B. Cost savings were primarily due to the lower drug acquisition costs and shorter IV LOT associated with voriconazole. Sensitivity analyses showed that the results were sensitive to drug price, particularly the cost of liposomal amphotericin B.ConclusionsVoriconazole is likely to be cost-saving compared with liposomal amphotericin B when used as a first-line treatment for IA in Germany and Spain.

Highlights

The current healthcare climate demands pharmacoeconomic evaluations for different treatment strategies incorporating drug acquisition costs, costs incurred for hospitalisation, drug administration and preparation, diagnostic and laboratory testing and drug-related adverse events (AEs)
German hospital perspective Based on clinical trial success rates of 52.8% for voriconazole and 50.0% for liposomal amphotericin B and a length of therapy (LOT) of 10 days for IV voriconazole followed by 5 days for oral voriconazole and 15 days for IV liposomal amphotericin B, voriconazole had a lower total treatment cost compared with liposomal amphotericin B (€12,256 versus €18,133) (Figure 2A)
If the same efficacy (50.0%) was assumed for both first-line therapies, voriconazole maintained a lower total treatment cost compared with liposomal amphotericin B (€12,836 versus €18,133, respectively, over 15 days of treatment, and €9,862 versus €12,250, respectively, over 10 days of treatment) (Figure 3A)

Summary

Introduction

The current healthcare climate demands pharmacoeconomic evaluations for different treatment strategies incorporating drug acquisition costs, costs incurred for hospitalisation, drug administration and preparation, diagnostic and laboratory testing and drug-related adverse events (AEs). We evaluate the pharmacoeconomics of voriconazole versus liposomal amphotericin B as first-line therapies for invasive aspergillosis (IA) in patients with haematological malignancy and prolonged neutropenia or who were undergoing haematopoietic stem-cell transplantation in Germany or Spain. Invasive fungal diseases (IFDs) are a significant cause of morbidity and mortality in immunocompromised patients, and are associated with increased healthcare costs [1]. The direct costs associated with IA are substantial and include inpatient and outpatient costs, such as increased LOS in hospital, costs of antifungal therapy, and costs related to the treatment of drug-related adverse events (AEs) [9]. Across Europe, treatment recommendations are managed at a national level and are based on a range of factors including: clinical outcomes (e.g. infection resolution and mortality), economic outcomes (e.g. treatment costs and hospital LOS) and quality of life information. In Spain, the Third European Conference on Infections and Leukaemia [12] and the Spanish Society of Infectious Diseases and Clinical Microbiology [13] provide specific therapies and disease-management strategies

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