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

Abstract

Background: We evaluated the cost-effectiveness of posaconazole compared with standard azole therapy (SAT; fluconazole or itraconazole) for the prevention of invasive fungal infections (IFI) and the reduction of overall mortality in high-risk neutropenic patients with acute myelogenous leukaemia (AML) or myelodysplastic syndromes (MDS). The perspective was that of the Spanish National Health Service (NHS).

Methods: A decision-analytic model, based on a randomised phase III trial, was used to predict IFI avoided, life-years saved (LYS), total costs, and incremental cost-effectiveness ratio (ICER; incremental cost per LYS) over patients' lifetime horizon. Data for the analyses included life expectancy, procedures, and costs associated with IFI and the drugs (in euros at November 2009 values) which were obtained from the published literature and opinions of an expert committee. A probabilistic sensitivity analysis (PAS) was performed.

Results: Posaconazole was associated with fewer IFI (0.05 versus 0.11), increased LYS (2.52 versus 2.43), and significantly lower costs excluding costs of the underlying condition (€6,121 versus €7,928) per patient relative to SAT. There is an 85% probability that posaconazole is a cost-saving strategy compared to SAT and a 97% probability that the ICER for posaconazole relative to SAT is below the cost per LYS threshold of €30,000 currently accepted in Spain.

Conclusions: Posaconazole is a cost-saving prophylactic strategy (lower costs and greater efficacy) compared with fluconazole or itraconazole in high-risk neutropenic patients.

Figure 1

Decision-tree model of posaconazole versus SAT (standard azole treatment; fluconazole or itraconazole) for the prevention of invasive fungal infection (IFI) among high-risk neutropenic patients. M = Markov model.

Figure 2

Probabilistic sensitivity analysis (PSA); incremental cost-effectiveness ratio (ICER) of posaconazole versus SAT (standard azole treatment; fluconazole or itraconazole) in the prevention of invasive fungal infection (IFI) among high-risk neutropenic patients (ICER threshold considered is €30,000 per life-year saved).

Figure 3

Cost-effectiveness acceptability curve; probability that posaconazole is cost-effective relative to SAT (standard azole treatment; fluconazole or itraconazole).