PIN36 - Clinical And Economic Outcomes Related To Invasive Aspergillosis Treatment With Voriconazol From The Public And Private Perspectives In Brazil

Abstract

Invasive aspergillosis (IA) is a severe infection that usually affects immunosuppressed patients in intensive care units (ICU), with high morbidity and mortality rates. This study assesses clinical and economic outcomes related to IA management with voriconazol (VCZ) versus amphotericin B (ANB), and liposomal amphotericin B (LAB) from private and public payer’s perspectives in Brazil. IA treatment was simulated in a decision-tree model with VCZ (6mg/kg twice, followed by 4mg/kg bid, 10 days), ANB (1.5mg/kg/day, 13 days), and LAB (3mg/kg/day, 13 days) and their associated costs in a 12-week time horizon. After first evaluation, responders continued with maintenance treatment and those with failure switched to a second treatment (caspofungin was also considered as rescue therapy). Efficacy data (clinical response), adverse events, and mortality rate were generated by meta-analysis based on systematic literature review. Costs included drugs, medical follow-up and adverse events management, collected from Brazilian private and public official databases (values represented 2013 BRL). Clinical response and mortality rate in 12 weeks were [56.67%; 34.1%], [36.42%; 50.9%], and [34.56%; 48.7%] for VCZ, ANB, and LAB, respectively. Total treatment costs with VCZ, ANB, and LAB were 40,635.71BRL, 18,570.14BRL and 86,646.42BRL from private, and 25,152.81BRL, 3,751.90BRL, and 62,107.87BRL from the public perspective, respectively. VCZ presented the highest response rate and lower mortality rate at 12 weeks. ANB was the least costly followed by VCZ. VCZ presented an economy of 46,010.71BRL and 36,955.07BRL when compared to LAB, from private and public perspectives, respectively. Main cost driver was related to drug acquisition (VCZ and LAB groups), and daily in ICU (ANB group). In this analysis, VCZ in IA treatment presented the greatest clinical response and the lower mortality rate when compared to ANB and LAB. Total treatment cost was higher than ANB but lower when compared to LAB in Brazilian private and public health care systems.