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Economic evaluation of posaconazole versus fluconazole prophylaxis in patients with graft-versus-host disease (GVHD) in the Netherlands.

Author(s): Jansen JP, O'Sullivan AK, Lugtenburg E, Span LF, Janssen JJ, Stam WB

Affiliation(s): Mapi Values, 133 Portland Street, Boston, MA 02114, USA. Jeroen.jansen@mapivalues.com

Publication date & source: 2010-09, Ann Hematol., 89(9):919-26. Epub 2010 Apr 10.

Publication type: Comparative Study; Randomized Controlled Trial; Research Support, Non-U.S. Gov't

The objective of this study was to evaluate the cost-effectiveness of posaconazole versus fluconazole for the prevention of invasive fungal infections (IFI) in graft-versus-host disease (GVHD) patients in the Netherlands. A decision analytic model was developed based on a double-blind randomized trial that compared posaconazole with fluconazole antifungal prophylaxis in recipients of allogeneic HSCT with GVHD who were receiving immunosuppressive therapy (Ullmann et al., N Engl J Med 356:335-347, 2007). Clinical events were modeled with chance nodes reflecting probabilities of IFIs, IFI-related death, and death from other causes. Data on life expectancy, quality-of-life, medical resource consumption, and costs were obtained from the literature. The total cost with posaconazole amounted to <euro>9,428 (95% uncertainty interval <euro>7,743-11,388), which is <euro>4,566 (<euro>2,460-6,854) more than those with fluconazole. Posaconazole prophylaxis resulted in 0.17 (0.02-0.36) quality adjusted life year (QALY) gained compared to fluconazole prophylaxis, corresponding to an incremental cost effectiveness ratio (ICER) of <euro>26,225 per QALY gained. A scenario analysis demonstrated that at an increased background IFI risk (from 9% to 15%) the ICER was <euro>13,462 per QALY. Given the underlying data and assumptions, posaconazole prophylaxis is expected to be cost-effective relative to fluconazole in recipients of allogeneic HSCT developing GVHD in the Netherlands. The cost-effectiveness of posaconazole depends on the IFI risk, which can vary by hospital.

Page last updated: 2010-10-05

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