Cost-Effectiveness Analysis of Isavuconazole vs. Voriconazole as First-Line Treatment for Invasive Aspergillosis

Abstract

IntroductionInvasive aspergillosis (IA) is associated with a significant clinical and economic burden. The phase III SECURE trial demonstrated non-inferiority in clinical efficacy between isavuconazole and voriconazole. No studies have evaluated the cost-effectiveness of isavuconazole compared to voriconazole. The objective of this study was to evaluate the costs and cost-effectiveness of isavuconazole vs. voriconazole for the first-line treatment of IA from the US hospital perspective.MethodsAn economic model was developed to assess the costs and cost-effectiveness of isavuconazole vs. voriconazole in hospitalized patients with IA. The time horizon was the duration of hospitalization. Length of stay for the initial admission, incidence of readmission, clinical response, overall survival rates, and experience of adverse events (AEs) came from the SECURE trial. Unit costs were from the literature. Total costs per patient were estimated, composed of drug costs, costs of AEs, and costs of hospitalizations. Incremental costs per death avoided and per additional clinical responders were reported. Deterministic and probabilistic sensitivity analyses (DSA and PSA) were conducted.ResultsBase case analysis showed that isavuconazole was associated with a $7418 lower total cost per patient than voriconazole. In both incremental costs per death avoided and incremental costs per additional clinical responder, isavuconazole dominated voriconazole. Results were robust in sensitivity analysis. Isavuconazole was cost saving and dominant vs. voriconazole in most DSA. In PSA, isavuconazole was cost saving in 80.2% of the simulations and cost-effective in 82.0% of the simulations at the $50,000 willingness to pay threshold per additional outcome.ConclusionIsavuconazole is a cost-effective option for the treatment of IA among hospitalized patients.FundingAstellas Pharma Global Development, Inc.Electronic supplementary materialThe online version of this article (doi:10.1007/s12325-016-0443-1) contains supplementary material, which is available to authorized users.

The cost-effectiveness of isavuconazole compared to the standard of care in the treatment of patients with invasive fungal infection prior to differential pathogen diagnosis in the United Kingdom

“…Very few studies evaluating the cost-effectiveness of isavuconazole have been published. A US hospital perspective model was published in 2017 and evaluated the cost-effectiveness of isavuconazole and voriconazole in terms of incremental cost per death avoided and incremental cost per responder, based on data from the SECURE trial 40 . The US model results favored the use of isavuconazole with a total cost per patient of $44,748 compared with $52,166 for voriconazole.…”

“…23,33 Economic analyses of isavuconazole have been performed relative to voriconazole in the treatment of IA and amphotericin B in mucormycosis, in several healthcare system settings. A US cost-effectiveness evaluation found isavuconazole to be a cost-effective treatment option relative to voriconazole in hospitalized patients with IA 40 . Another cost-effectiveness analysis took a Swedish healthcare payer perspective and found treatment of possible IA (at the point of treatment initiation, a differential diagnosis between IA and mucormycosis had not been achieved) with isavuconazole to be cost-effective compared with voriconazole 41 .…”

Spotlight on isavuconazole in the treatment of invasive aspergillosis and mucormycosis: design, development, and place in therapy

“…When compared to voriconazole, isavuconazole has been reported to be cost-effective for the first-line treatment of IA. 83 Economic modeling assessed a cost saving of 7,418 US dollars per patient for isavuconazole compared to voriconazole. Astellas Pharma Global Development, Inc. funded this study.…”

Cost-effectiveness analysis of isavuconazole versus voriconazole for the treatment of patients with possible invasive aspergillosis in Sweden

“…Since isavuconazole and voriconazole each have different spectra of antifungal activity and safety profiles, it is important to determine their relative cost effectiveness. From a US hospital perspective, isavuconazole has been demonstrated to be a cost-effective treatment for IA in hospitalised patients compared with voriconazole [16]. However, the cost-effectiveness of isavuconazole compared with voriconazole in European countries has not been reported.…”