Purpose: Toassess costs, outcomes (number of IFIs avoided; improvement in overall mortality), and cost-effectiveness of prophylaxis with oral posaconazole (200 mg TID) vs. oral standard azoles (fluconazole 400 mg once daily or itraconazole 200 mg BID) in neutropenic patients with AML or MDS. Methods: A decisional tree economic model was developed to evaluate the cost-effectiveness of posaconazole vs standard azolesfrom the perspective of the Italian hospital. Clinical probabilities of IFIs; death given IFIs; and death from other causes were obtained from a Phase 3 randomized, prospective, multicenter, international clinical trial. The model’s time horizon was based on the treatment period + 100-day follow-up period as described in the abovementioned clinical trial.Healthcare sector related costs (drugs and related administration; hospitalization due to IFIs in haematological ward or in ICU), expressed in Euros 2009 values, were evaluated using data from the clinical trial, literature and research hypotheses.The robustness of the cost-effectiveness model was tested via one-way and probabilistic sensitivity analyses. Results: Results from the base case analysis (Table below) suggest that prophylaxis with posaconazole is more costly (additional Euros 1025.30) and more effective than standard azoles. Cost drivers are the cost of posaconazole (75.43% of the overall cost) and the cost of managing IFIs (82.60% of the overall cost), for patients treated with posaconazole and standard azoles, respectively. Sensitivity analyses confirm that the economic model is robust. With regard to avoided IFIs (avoided overall mortality), the cost-effectiveness acceptability curve highlights that from a threshold value of Euros 16,000 (Euros 18,100) onwards, the probability for posaconazole to be cost-effective vs standard azoles is steadily increasing. Conclusions: The current clinical and economic evidence suggest that the use of posaconazole as prophylaxis in neutropenic patientswithAML or MDS who are at risk for IFI is "œgood value for money" for Italian hospitals. These results should be confirmed with clinical and health economic studies performed in the Italian setting.
Full conference title:
4th Advances Against Aspergillosis
- AAA 4th (2010)