Treatment cost development of patients undergoing remission induction chemotherapy: a pharmacoeconomic analysis before and after introduction of posaconazole prophylaxis

Authors

  • Sebastian M. Heimann,

    1. 1st Department of Internal Medicine, University Hospital of Cologne, Cologne, Germany
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  • Oliver A. Cornely,

    1. 1st Department of Internal Medicine, University Hospital of Cologne, Cologne, Germany
    2. Clinical Trials Centre Cologne, ZKS Köln, University Hospital of Cologne, Cologne, Germany
    3. Center for Integrated Oncology Köln Bonn, CIO Köln Bonn, University Hospital of Cologne, Cologne, Germany
    4. Cluster of Excellence – Cellular Stress Responses in Aging-Associated Diseases, CECAD, University Hospital of Cologne, Cologne, Germany
    5. German Centre for Infection Research (DZIF), partner site Bonn-Cologne, Cologne, Germany
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  • Maria J. G .T. Vehreschild,

    1. 1st Department of Internal Medicine, University Hospital of Cologne, Cologne, Germany
    2. German Centre for Infection Research (DZIF), partner site Bonn-Cologne, Cologne, Germany
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  • Jan Glossmann,

    1. 1st Department of Internal Medicine, University Hospital of Cologne, Cologne, Germany
    2. Center for Integrated Oncology Köln Bonn, CIO Köln Bonn, University Hospital of Cologne, Cologne, Germany
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  • Matthias Kochanek,

    1. 1st Department of Internal Medicine, University Hospital of Cologne, Cologne, Germany
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  • Karl-Anton Kreuzer,

    1. 1st Department of Internal Medicine, University Hospital of Cologne, Cologne, Germany
    2. Center for Integrated Oncology Köln Bonn, CIO Köln Bonn, University Hospital of Cologne, Cologne, Germany
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  • Michael Hallek,

    1. 1st Department of Internal Medicine, University Hospital of Cologne, Cologne, Germany
    2. Center for Integrated Oncology Köln Bonn, CIO Köln Bonn, University Hospital of Cologne, Cologne, Germany
    3. Cluster of Excellence – Cellular Stress Responses in Aging-Associated Diseases, CECAD, University Hospital of Cologne, Cologne, Germany
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  • Jörg J. Vehreschild

    Corresponding author
    1. 1st Department of Internal Medicine, University Hospital of Cologne, Cologne, Germany
    2. German Centre for Infection Research (DZIF), partner site Bonn-Cologne, Cologne, Germany
    • Correspondence: J. J. Vehreschild, MD, University Hospital of Cologne, 1st Department of Internal Medicine, Kerpener Straße 62, 50937 Cologne, Germany.

      Tel.: +(00)49 221 478 6494. Fax: +(00)49 221 478 3611

      E-mail: janne.vehreschild@ctuc.de

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Summary

Prior clinical trials have demonstrated efficacy and effectiveness of posaconazole in the prophylaxis of invasive fungal diseases in high-risk patients. Controversy exists about the cost-effectiveness of this approach. We performed an analysis comparing the direct costs of posaconazole prophylaxis against polyene mouthwash (thrush) prophylaxis in patients with acute myelogenous leukaemia (AML). Data of AML patients receiving remission-induction chemotherapy were extracted from the CoCoNut (Cologne Cohort of Neutropenic Patients) database to compare hospital costs of patients before (2003–2005) and after (2006–2008) introduction of posaconazole prophylaxis. Treatment on general ward, intensive care unit (ICU), mechanical ventilation, diagnostic procedures, and all anti-infectives were calculated. Patient groups were well matched according to age, gender and duration of neutropenia. The mean costs per patient in the posaconazole group (n = 76) and the polyene mouthwash group (n = 81) were €21 040 (95% confidence interval (CI): €18 204–€23 876) and €23 169 (95% CI: €19 402–€26 937) per patient. Antifungal treatment costs were €4580 (95% CI: €3678–€5482) and €4019 (95% CI: €2825–€5214). Duration on the ICU was 2582 (95% CI: 984.1–4181.7) and 5517 (95% CI: 2206–8827.3) min. In our hospital, primary antifungal prophylaxis by posaconazole was cost-effective. There was a trend towards cost savings, which was primarily caused by a shorter overall length of stay and the less frequent ICU treatment.

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