Cost-effectiveness of posaconazole vs. fluconazole in the prevention of invasive fungal infections among patients with graft-versus-host disease in Spain

Abstract number: P1028

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

Background: Ullman et al. (NEJM 2007) had shown in a recent clinical trial that posaconazole (POS) is similar to fluconazole (FLU) in the prevention of invasive fungal infections (IFIs) among allogeneic hematopoietic stem-cell transplant (HSCT) patients with graft-versus-host disease (GVHD).

Objectives: To assess the cost-effectiveness of POS versus FLU in preventing IFI in patients with GVHD from the Spanish National Health System perspective.

Methods: A decision-analytic model was developed to assess the average per patient treatment costs, IFIs avoided, life-years gained, and incremental cost per life-year gained of each prophylactic treatment ([euro] 2007). The trial results were extrapolated to a lifetime horizon by extending the model with one-month Markov cycles including specific mortality risk for GVHD. Patients are assumed to receive POS or FLU; probability of IFI, IFI-related death and death from other causes were obtained from the published clinical trial. Long-term mortality and prophylaxis drug and IFI treatment costs were estimated from secondary sources. One-way and probabilistic sensitivity analyses were conducted.

Results: preliminary results shows that POS is associated with fewer IFIs (0.05 vs. 0.09), increased life years (8.01 vs. 7.78), and higher IFI-related costs (prophylaxis and IFI treatment) ([euro]11.585 vs. [euro]6.959) per patient relative to FLU over a lifetime horizon. Costs for treatment of IFIs comprised 82% of the total cost for FLU and 29% for POS. The incremental cost-effectiveness of POS versus FLU is estimated to be [euro]20.246 per life-year saved. Results are most sensitive to changes in the cost of preventing an IFI and the efficacy of prophylaxis. A second-order probabilistic Monte Carlo sensitivity analysis was conducted to assess the effects of parameter uncertainty on the study findings, particularly as relates to treatment efficacy and the costs of preventing an IFI. Results indicate that there is a 70% probability that POS is cost-effective at a [euro]30.000 per life year saved threshold, threshold commonly used in Spain for assessing the cost-effectiveness of new technologies.

Conclusion: Based on this analysis, we conclude that posaconazole is a cost-effective strategy in Spain for the prevention of IFIs among patients with GVHD.

Session Details

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