Cost-effectiveness analysis of combination antifungal therapy with voriconazole and anidulafungin versus voriconazole monotherapy for primary treatment of invasive aspergillosis in Spain

Abstract

ObjectiveAccording to a recent randomized, double-blind clinical trial comparing the combination of voriconazole and anidulafungin (VOR+ANI) with VOR monotherapy for invasive aspergillosis (IA) in patients with hematologic disease or with hematopoietic stem cell transplant, mortality was lower after 6 weeks with VOR+ANI than with VOR monotherapy in a post hoc analysis of patients with galactomannan-based IA. The objective of this study was to compare the cost-effectiveness of VOR+ANI with VOR, from the perspective of hospitals in the Spanish National Health System.MethodsAn economic model with deterministic and probabilistic analyses was used to determine costs per life-year gained (LYG) for VOR+ANI versus VOR in patients with galactomannan-based IA. Mortality, adverse event rates, and life expectancy were obtained from clinical trial data. The costs (in 2015 euros [€]) of the drugs and the adverse event-related costs were obtained from Spanish sources. A Tornado plot and a Monte Carlo simulation (1,000 iterations) were used to assess uncertainty of all model variables.ResultsAccording to the deterministic analysis, for each patient treated with VOR+ANI compared with VOR monotherapy, there would be a total of 0.348 LYG (2.529 vs 2.181 years, respectively) at an incremental cost of €5,493 (€17,902 vs €12,409, respectively). Consequently, the additional cost per LYG with VOR+ANI compared with VOR would be €15,785. Deterministic sensitivity analyses confirmed the robustness of these findings. In the probabilistic analysis, the cost per LYG with VOR+ANI was €15,774 (95% confidence interval: €15,763–16,692). The probability of VOR+ANI being cost-effective compared with VOR was estimated at 82.5% and 91.9%, based on local cost-effectiveness thresholds of €30,000 and €45,000, respectively.ConclusionAccording to the present economic study, combination therapy with VOR+ANI is cost-effective as primary therapy of IA in galactomannan-positive patients in Spain who have hematologic disease or hematopoietic stem cell transplant, compared with VOR monotherapy.

The cost‐effectiveness of isavuconazole compared to voriconazole, the standard of care in the treatment of patients with invasive mould diseases, prior to differential pathogen diagnosis in Spain

“…6 IMDs have a high economic impact as well. 1,7,8 In line with available data in the website of the Spanish Ministry of Health RAE-CMBD (Registro Atención Especializada-Conjunto Mínimo Básico de Datos), 9 length of stay for IA in Spain in 2017 was 54.20 days and the mean associated costs were 18,235€; regarding IM the length of stay was 70 days and the mean costs were 24,020€.…”

“…For instance, according to a study analysed by the FDA, a delay of 6 days in the initiation of treatment, increased mortality rates up to almost two times, from 48.6% to 82.9% 6 . IMDs have a high economic impact as well 1,7,8 . In line with available data in the website of the Spanish Ministry of Health RAE‐CMBD (Registro Atención Especializada‐ Conjunto Mínimo Básico de Datos), 9 length of stay for IA in Spain in 2017 was 54.20 days and the mean associated costs were 18,235€; regarding IM the length of stay was 70 days and the mean costs were 24,020€.…”

Disseminated multi-organ aspergillosis with acute cerebral infarction in a patient with myelodysplastic syndrome. A case report.

“…(12) Although clinical data on voriconazole in combination with echinocandins for the treatment of CNS-IA are still limited, some studies have indicated that this combination can improve the survival outcomes of patients with pulmonary-IA infections. (13) Considering that the patient in the present had a disseminated Aspergillus infection involving multiple organs, we adopted a treatment regimen of voriconazole in conjunction with caspofungin. Although the patient presented herein eventually died, his clinical symptoms and imaging examinations after one week of this combined treatment indicated that this treatment regimen might be effective against the A. nidulans strain.…”