Antifungal prophylaxis in acute myeloid leukaemia patients receiving chemotherapy is cost-effective in a resource-limited country

Teeramet Pungprasert *1, Ployploen Phikulsod 2;3, Varalak Srinonprasert 2;3, Dhanach Dhirachaikulpanich 2;3, Narisa Tantai 2;3, Satanun Maneeon 2;3

Author address: 

1 Wang Nuea Hospital, Lampang, Thailand; 2 Mahidol University, Tambon Salaya, Thailand; 3 Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok , Thailand


Background: Invasive fungal infections (IFI) cause high morbidity and mortality in acute myeloblastic leukemia (AML) patients receiving chemotherapy. Antifungal prophylaxis is recommended in this setting. However, due to the healthcare reimbursement policy, this intervention is not widely implemented in resource-limited countries. We aimed to investigate the cost-effectiveness of antifungal prophylaxis in Thailand.

Materials/methods: A model estimating costs and outcomes from a hypothetical cohort of 1,000 AML patients receiving antifungal prophylaxis was established. Due to local high incidence of aspergillosis, anti-mold agents available in Thailand were included in this study; itraconazole (capsule and solution), posaconazole (solution) and voriconazole (tablet). Clinical efficacies of the antifungal drugs were obtained from a network-meta analysis study. The model accounted for the incidence rate, cost of care, healthcare resource utilization and 100-day outcomes of patients with IFI. These were based on previous local studies, a hospital registry, expert opinions, and a national healthcare price list. Results represented the extrapolated cost, lifeyear saved (LYs) and health outcome with quality-adjusted life-years (QALYs). The probabilistic incremental cost-effectiveness ratios (ICERs) were calculated from a provider’s perspective. A one-way sensitivity analysis was also performed.

Results: Itraconazole capsule, solution, and voriconazole were dominant and cost-saving options. They resulted in LYs and QALYs gaining when compared to no prophylaxis. In a sensitivity analysis, at willingness to pay (WTP) threshold of the nation’s per-capita gross domestic product per QALYs gain (160,000 THB; 5291.01 USD), the probabilities that providing voriconazole would be cost-effective is highest followed by itraconazole capsule and solution. Posaconazole was also cost-effective (ICERs of 118,514 THB; 3924.31 USD/QALY gain) and gave the highest LYs and QALYs gain (0.19, 0.15).

Conclusions: Itraconazole, voriconazole, and posaconazole were all cost-effective with the itraconazole capsule being the most cost-saving. Overall, voriconazole would be considered the most cost-effective option for IFI prevention during AML treatment in this model. Antifungal prophylactic therapy, although considered expensive in Thailand, may improve clinical outcomes and reduce the economic burden of AML treatment.

Presenter email address: [email protected]


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Full conference title: 

European Congress of Clinical Microbiology and Infectious Diseases 2020
    • ECCMID 30th (2020)