Economic evaluation of posaconazole versus standard azole prophylaxis in high risk neutropenic patients in the Netherlands.

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

Affiliation(s): Mapi Values, Houten, the Netherlands.

Publication date & source: 2008-08-27, Eur J Haematol., [Epub ahead of print]

Publication type:

Background: Acute leukemia (AML) and myelodysplastic syndrome (MDS) patients experience prolonged neutropenia after treatment with intensive chemotherapy, leading to a high risk of invasive fungal infections (IFI). The present study evaluates the cost-effectiveness of posaconazole versus standard azoles for the prevention of IFIs in neutropenic patients in the Netherlands. Methods: A decision-tree model was developed using data from a randomized trial that compared posaconazole and standard azole (fluconazole or itraconazole) prophylaxis in neutropenic patients receiving remission-induction chemotherapy for AML/MDS (Cornely et al., 2007). Following initiation of prophylaxis, clinical events are modeled with chance nodes reflecting probabilities of IFIs, IFI related death, and death from other causes. Patients surviving the prophylaxis are assumed to have a life expectancy according to the underlying condition. This allows translation of the trial outcomes to a lifetime horizon. Data on life expectancy, quality of life, medical resource consumption and costs were obtained from the literature. Model outcomes include cost per life year gained and cost per QALY gained. Results: The total cost (treatment of breakthrough IFI + prophylaxis) for posaconazole amounted to euro4,412 (95% uncertainty interval euro3,403 -euro5,666), which is - euro183 (-euro1,985 - euro1,564) less than costs with standard azoles. Posaconazole prophylaxis resulted in 0.08 (0.02 - 0.15) QALYs gained in comparison to prophylaxis with standard azoles. Results from a probabilistic sensitivity analysis indicate that there is a 90% probability that the cost per QALY gained with posaconazole is below euro20,000. Additional scenario analyses with different assumptions confirmed these findings. Conclusion: Given the underlying data and assumptions, the economic evaluation demonstrated that posaconazole prophylaxis is expected to be cost effective compared to fluconazole / itraconazole in neutropenic AML/MDS patients after intensive chemotherapy.