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Cost-effectiveness of posaconazole versus standard azole treatment (fluconazole or itraconazole) in the prevention of invasive fungal infections among high-risk neutropenic patients in Spain

Abstract number: P1027

Grau S., de la Cámara R., Sanz M., Carreras E., Jarque I., Casado M.A., Sabater F.J., Papadopoulos G.

Background: Posaconazole (POS) has demonstrated to be superior to standard azole therapy (SAT; fluconazole or itraconazole) in preventing both invasive fungal infections (IFIs) and reducing overall mortality among high-risk neutropenic patients (Cornely 2007).

Objectives: To evaluate the cost-effectiveness of POS compared with SAT for the prevention of IFIs among patients with acute myelogenous leukaemia (AML) or myelodysplastic syndromes (MDS) who are at high-risk of developing an IFI due to chemotherapy-induced neutropenia.

Methods: A decision-analytic model was used to predict the likelihood of IFI and death, using published data from the Cornely trial. Patients in the model were assumed to have received prophylaxis with POS or SAT (fluconazole, 81%; itraconazole, 19%). Clinical results were extrapolated to lifetime horizon by extending the model with 1-month Markov cycles including specific mortality risk for underlying diseases. Model outcomes include IFIs avoided, life-years saved, total costs, incremental cost per IFI avoided, and incremental cost-effectiveness ratio (ICER; incremental cost per life year saved) of POS versus SAT over a lifetime. The analysis was done from the perspective of the Spanish HealthCare System. Data on life expectancy were obtained from Spanish Statistics Institute. Information on medical procedures was obtained from the Cornely study and an expert committee. Costs for IFI treatment and drug/administration costs were taken from published literature ([euro]2007 values). A deterministic and probabilistic sensitivity analyses (PAS) were performed.

Results: POS is associated with fewer IFIs (0.05 versus 0.11 p = 0.003), increased life years (2.52 versus 2.43), and (excluding costs of the underlying condition) significantly lower costs ([euro]5,911 versus [euro]7,475) per patient relative to SAT over a lifetime horizon. Results from the PSA indicate that there is an 87% probability that POS is a cost-saving strategy versus SAT and that the probability that the ICER ratio for POS versus SAT is below an estimated [euro]30,000 per life year saved threshold is 98%.

Conclusion: Posaconazole has been shown to be more effective than standard azole therapy in preventing IFIs and reducing overall mortality in high-risk neutropenic patients. An incremental cost-effectiveness analysis done from the perspective of the Spanish HealthCare System, has indicated the dominance (lower costs and greater efficacy) of posaconazole versus fluconazole or itraconazole.

Session Details

Date: 19/04/2008
Time: 00:00-00:00
Session name: 18th European Congress of Clinical Microbiology and Infectious Diseases
Subject:
Location: Barcelona, Spain
Presentation type:
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