Abstract
BackgroundInvasive mould diseases are associated with high morbidity, mortality and economic impact. Its treatment is often started prior to differential pathogen diagnosis. Isavuconazole is approved for treatment of invasive aspergillosis (IA) and invasive mucormycosis (IM) when amphotericin‐B is not indicated.ObjectivesTo estimate the cost‐effectiveness of isavuconazole vs voriconazole for the treatment of adult patients with possible IA prior to differential pathogen diagnosis, in Spain.MethodsA decision tree analysis was performed using the Spanish Healthcare System perspective. Among all patients with possible IA, it was considered that 7.81% actually had IM. Costs for laboratory analysis, management of adverse events, hospitalisation and drugs per patient, deaths and long‐term effects in life years (LYs) and quality‐adjusted LYs (QALYs) were considered. Efficacy data were obtained from clinical trials and utilities from the literature. Deterministic and probabilistic sensitivity analyses (PSA) were conducted.ResultsIn patients with possible IA and when compared to voricanozole, isavuconazole showed an incremental cost of 4758.53€, besides an incremental effectiveness of +0.49 LYs and +0.41 QALYs per patient. The Incremental Cost Effectiveness Ratio was 9622.52€ per LY gained and 11,734.79€ per QALY gained. The higher cost of isavuconazole was due to drug acquisition. Main parameters influencing results were mortality, treatment duration and hospitalisation days. The PSA results showed that isavuconazole has a probability of being cost‐effective of 67.34%, being dominant in 24.00% of cases.ConclusionsIsavuconazole is a cost‐effective treatment compared to voriconazole for patients with possible IA for a willingness to pay threshold of 25,000€ per additional QALY.
Highlights
Invasive mould diseases (IMD) are life-threatening infections, especially in immunocompromised patients such as those with haematologic diseases, those who have been subjected to a solid organ transplantation or haematopoietic stem cell transplantation (HSCT) and in critically ill patients with leukaemia or profound neutropaenia.[1,2]
IMDs are caused by fungus of the genus Aspergillus or other filamentous fungi, for example, Mucorales
These infections entail an important clinical burden to individuals who are already vulnerable as they are associated with high morbidity and mortality, with mortality rates ranging from 30% to 80% for invasive aspergillosis (IA) and up to 97% when untreated invasive mucormycosis (IM).[3,4]
Summary
Invasive mould diseases (IMD) are life-threatening infections, especially in immunocompromised patients such as those with haematologic diseases, those who have been subjected to a solid organ transplantation or haematopoietic stem cell transplantation (HSCT) and in critically ill patients with leukaemia or profound neutropaenia.[1,2] IMDs are caused by fungus of the genus Aspergillus (causing invasive aspergillosis, IA) or other filamentous fungi, for example, Mucorales (causing invasive mucormycosis, IM) These infections entail an important clinical burden to individuals who are already vulnerable as they are associated with high morbidity and mortality, with mortality rates ranging from 30% to 80% for IA and up to 97% when untreated IM.[3,4] a delay in the establishment of an adequate therapy leads to increased mortality rates in certain type of patients and significant increase in treatment duration.[5] For instance, according to a study analysed by the FDA, a delay of 6 days in the initiation of treatment, increased mortality rates up to almost two times, from 48.6% to 82.9%.6. Conclusions: Isavuconazole is a cost-effective treatment compared to voriconazole for patients with possible IA for a willingness to pay threshold of 25,000€ per additional QALY
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