PIN44 Cost-Effectiveness of Posaconazole Compared to Fluconazole/Itraconazole for the Prevention of Invasive Fungal Infections in Neutropenic Patients

Abstract

Invasive Fungal Infections (IFIs) present a major issue in clinical practice, due to their high morbidity and mortality rates. In a pivotal multicentre, randomized clinical trial posaconazole prophylaxis prevented IFIs more effectively than did either fluconazole or itraconazole, and improved overall survival. The aim of this study was to perform an economic evaluation of the afore-mentioned therapeutic strategies for IFI prophylaxis in neutropenic patients, in the Greek health care setting. A decision analytic model was developed, which described the course of neutropenic patients under posaconazole or standard azole (fluconazole or itraconazole) treatment. The effectiveness data for each treatment regimen were derived from published results of a pivotal, multicentre, randomized clinical trial. The cost and health care resources utilization data used, depict Greek clinical practice and are derived from official Greek sources. In order to obtain some of the model imputs, expert opinion from Greek Hematologists specializing in treating IFIs, was also used. Prophylaxis with Posaconazole resulted in fewer IFIs (0,05 vs. 0,11 per patient) compared to treatment with fluconazole or itraconazole, during the first 100 days from initiation of prophylaxis treatment. The cost per avoided IFI with Posaconazole was 6,455€, while the cost for every incremental life year gained (LYG) was estimated at 24,196€. Extensive sensitivity analyses (one-way and probabilistic) corroborated the base-case results. The utilization of Posaconazole for prophylaxis of IFIs in hematology patients with neutropenia is a therapeutic strategy that provides superior clinical efficacy, while being cost-effective compared to alternative therapies.