Abstract
BackgroundInvasive fungal infections (IFI) are associated with considerable expense and mortality on healthcare systems. There is a need to provide evidence of both clinical efficacy and value for money with any health technology. The current pharmacoeconomic evaluation investigated the use of liposomal amphotericin B (LAmB) and voriconazole for the empiric treatment of IFI in the Turkish setting.MethodsDecision analytic modelling was used to create a pathway for patient treatment with a 5-point composite outcome measure. The data was obtained from a major non-inferiority multicentre randomised controlled study, with an expert panel of clinicians in Turkey providing transition probabilities and cost not available in the literature. Sensitivity analyses were performed on the inputs from the clinical trial and the expert panel.ResultsAs per the base case analysis, voriconazole was preferred by Turkish Lira (TL) 2,523 per patient treated and TL2,520 per surviving patient. LAmB was the preferred alternative by TL5,362 per successfully treated patient. Removing fever resolution as part of the composite outcome measure resulted in voriconazole being the preferred alternative per successfully treated patient. Univariate sensitivity analysis highlighted that increasing the duration of voriconazole by >1.2 days or decreasing LAmB by >1.0 days changes the result. Monte Carlo Simulation resulted in 69.4% of simulations favouring voriconazole per patient treated.ConclusionThere is a strong likelihood that voriconazole is economically more favourable than LAmB in the empiric treatment of IFI in Turkey.
Highlights
Invasive fungal infections (IFI) are associated with considerable expense and mortality on healthcare systems
liposomal amphotericin B (LAmB) was the preferred alternative by TL5,362 per successfully treated patient
LAmB had a higher probability of success and lower mortality than voriconazole (30.57% vs. 26.02% and 5.92% vs. 7.95%, respectively) [3]
Summary
Invasive fungal infections (IFI) are associated with considerable expense and mortality on healthcare systems. The current pharmacoeconomic evaluation investigated the use of liposomal amphotericin B (LAmB) and voriconazole for the empiric treatment of IFI in the Turkish setting. Invasive fungal infections (IFIs) are predominantly an adverse outcome associated with an immunocompromised health state [1]. This is often encountered in prolonged neutropenia resulting from chemotherapy treatments [1]. The cost to the healthcare systems for treating IFIs (including antifungal medications, extended hospital stays and other monitoring costs) are of significant concern [2,3]. Liposomal amphotericin B (LAmB) has been a mainstay in the empiric treatment of IFI [4,5]. All currently used antifungal agents are costly, with the treatment duration being upwards of 1-2 weeks [2]
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