Abstract
Posaconazole is used at the National Center for Cancer Care and Research (NCCCR, Qatar) in immunocompromised patients with cancer, who are undergoing chemotherapy or hematopoietic stem cell transplantation (HSCT), for preventing invasive fungal infections (IFIs). The current study was a cost-analysis of the prophylactic posaconazole in cancer patients in the NCCCR, Qatar. Data was retrospectively extracted from the CERNER database at NCCCR (during 2013-2015) and published clinical trials. A decision analytic simulation model was developed from the hospital perspective to follow up patients for 112 days, including consequences of three possible outcomes of prophylaxis; success, failure, and death. Success was defined as no infections during follow up. Success can be with minor or major adverse drug reactions (ADRs). SensitivIty and uncertainty analyses were conducted to confirm study robustness. Based on a random sample of 70 patients, probabilities of success, IFIs, and death were 0.5, 0.43, and 0.07, respectively. The average acquisition cost of posaconazole reached QAR 26,365/patient (USD 1 = Qatar Riyal (QAR) 3.65) with an average 55.2 days of prophylaxis. The overall cost of posaconazole was QAR 109,802/patient, with major ADRs, related to biliary and hepatic disorders, contributing to 30% of this cost, followed by the cost of monitoring tests (19%), and the Candida IFIs (17.5%). Over QAR 1,080,000 were spent on monitoring and diagnostics tests in enrolled patients. The study outcome was sensitive to the scenario of having no major ADRs (QAR 109,802.3 vs. 83,432.8). This is the first cost-analysis of prophylactic posaconazole in Qatar, and the first internationally to report the impact of the major ADRs of posaconazole. The main cost driver was the treatment of major ADRs, with the minimizing of these considerably reducing the cost of prophylactic posaconazole. Alternatives to posaconazole should be considered in cases with risks for major ADRs.
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