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Cost-Effectiveness of Posaconazole versus Fluconazole or Itraconazole in the Prevention of Invasive Fungal Infections among Neutropenic Patients in the United States

  1. Amy K. O'Sullivan PhD1,
  2. Ankur Pandya MS1,
  3. George Papadopoulos BSc(Hons)2,
  4. David Thompson PhD1,
  5. Amelia Langston MD3,
  6. John Perfect MD4,
  7. Milton C. Weinstein PhD5

Article first published online: 12 JAN 2009

DOI: 10.1111/j.1524-4733.2008.00486.x

Issue

Value in Health

Value in Health

Volume 12, Issue 5, pages 666–673, July/August 2009

Additional Information

How to Cite

O'Sullivan, A. K., Pandya, A., Papadopoulos, G., Thompson, D., Langston, A., Perfect, J. and Weinstein, M. C. (2009), Cost-Effectiveness of Posaconazole versus Fluconazole or Itraconazole in the Prevention of Invasive Fungal Infections among Neutropenic Patients in the United States. Value in Health, 12: 666–673. doi: 10.1111/j.1524-4733.2008.00486.x

Author Information

  1. 1

    i3 Innovus, Medford, MA, USA;

  2. 2

    Schering-Plough Corporation, Kenilworth, NJ, USA;

  3. 3

    Winship Cancer Institute, Emory University, Atlanta, GA, USA;

  4. 4

    Duke Medical Center, Durham, NC, USA;

  5. 5

    Harvard School of Public Health, Boston, MA, USA

*Amy K. O'Sullivan, i3 Innovus, 10 Cabot Road, Suite 304, Medford, MA 02155, USA. E-mail: amy.osullivan@i3innovus.com

Publication History

  1. Issue published online: 22 JUN 2009
  2. Article first published online: 12 JAN 2009

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Keywords:

  • cost-effectiveness;
  • decision analysis;
  • invasive fungal infection;
  • prophylaxis

ABSTRACT

Objectives:  Clinical trial data indicate that posaconazole is superior to fluconazole (FLU) or itraconazole (ITRA) in preventing invasive fungal infections (IFIs) among neutropenic patients. Our objective was to assess the cost-effectiveness of posaconazole versus FLU or ITRA for prevention of IFIs among neutropenic patients.

Methods:  We used modeling techniques to assess the cost-effectiveness of posaconazole versus FLU or ITRA in the prevention of IFIs among patients with acute myelogenous leukemia (AML) or myelodysplastic syndromes (MDS) and chemotherapy-induced neutropenia. The probabilities of experiencing an IFI, IFI-related death, and death from other causes over 100 days of follow-up were estimated from clinical trial data. Long-term mortality, drug costs, and IFI treatment costs were obtained from secondary sources.

Results:  Posaconazole is associated with fewer IFIs per patient (0.05 vs. 0.11) relative to FLU or ITRA over 100 days of follow-up, and lower discounted costs ($3900 vs. $4500) and increased life-years (2.50 vs. 2.43 discounted) over a lifetime horizon. Results from a probabilistic sensitivity analysis indicate that there is a 73% probability that posaconazole is cost saving versus FLU or ITRA and a 96% probability that the incremental cost-effectiveness ratio for posaconazole is at or below $50,000 per life-year saved.

Conclusions:  We conclude that posaconazole is very likely to be a cost-effective alternative to FLU or ITRA in the prevention of IFIs among neutropenic patients with AML and MDS, and may result in cost savings.

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