Abstract
BackgroundWe evaluated the cost-effectiveness of posaconazole compared with standard azole therapy (SAT; fluconazole or itraconazole) for the prevention of invasive fungal infections (IFI) and the reduction of overall mortality in high-risk neutropenic patients with acute myelogenous leukaemia (AML) or myelodysplastic syndromes (MDS). The perspective was that of the Spanish National Health Service (NHS).MethodsA decision-analytic model, based on a randomised phase III trial, was used to predict IFI avoided, life-years saved (LYS), total costs, and incremental cost-effectiveness ratio (ICER; incremental cost per LYS) over patients' lifetime horizon. Data for the analyses included life expectancy, procedures, and costs associated with IFI and the drugs (in euros at November 2009 values) which were obtained from the published literature and opinions of an expert committee. A probabilistic sensitivity analysis (PAS) was performed.ResultsPosaconazole was associated with fewer IFI (0.05 versus 0.11), increased LYS (2.52 versus 2.43), and significantly lower costs excluding costs of the underlying condition (€6,121 versus €7,928) per patient relative to SAT. There is an 85% probability that posaconazole is a cost-saving strategy compared to SAT and a 97% probability that the ICER for posaconazole relative to SAT is below the cost per LYS threshold of €30,000 currently accepted in Spain.ConclusionsPosaconazole is a cost-saving prophylactic strategy (lower costs and greater efficacy) compared with fluconazole or itraconazole in high-risk neutropenic patients.
Highlights
We evaluated the cost-effectiveness of posaconazole compared with standard azole therapy (SAT; fluconazole or itraconazole) for the prevention of invasive fungal infections (IFI) and the reduction of overall mortality in high-risk neutropenic patients with acute myelogenous leukaemia (AML) or myelodysplastic syndromes (MDS)
In the analysis we considered that one of the strategies is efficient if the cost per lifeyears saved (LYS) is less than the threshold of efficiency currently accepted in Spain, and which has been established at < €30,000 euros per LYS [38]
Base case analysis In the base case over the 100 first days of prophylaxis, the IFI per patient in the SAT group was 0.11 versus 0.05 in the posaconazole group (Table 3), i.e. posaconazole avoided a mean of 0.06 IFI per patient
Summary
We evaluated the cost-effectiveness of posaconazole compared with standard azole therapy (SAT; fluconazole or itraconazole) for the prevention of invasive fungal infections (IFI) and the reduction of overall mortality in high-risk neutropenic patients with acute myelogenous leukaemia (AML) or myelodysplastic syndromes (MDS). Patients with neutropenia as a result of chemotherapy for acute myelogenous leukaemia (AML) or myelodysplastic syndrome (MDS) are at high risk of developing invasive fungal infection (IFI) [1,2,3,4,5,6,7]. Posaconazole is a new-generation oral azole [9] that has been demonstrated to be superior to standard azole therapy (SAT; fluconazole or itraconazole) in preventing IFI and reducing overall mortality in high-risk neutropenic patients [10]. Posaconazole is recommended in major clinical guidelines [12,13,14,15] as prophylaxis for neutropenic patients with AML or MDS (category 1/A-I)
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