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

Stam, Wiro; O’Sullivan, Amy K.; Rijnders, Bart J. A.; Lugtenburg, Elly; Span, L. F. R.; Janssen, Jeroen; Jansen, Jeroen P.

doi:10.1111/j.1600-0609.2008.01141.x

Cited by 48 publications

(57 citation statements)

References 27 publications

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“…These findings correspond to evaluations with the generic model in other countries. Although there were differences in the evaluation and range of costs between these analyses, they all revealed that posaconazole prophylaxis can be considered a cost-effective strategy by preventing fungal infections [23,24,25,26]. …”

Section: Discussionmentioning

confidence: 99%

Cost-Effectiveness of Posaconazole Compared with Standard Azole Therapy for Prevention of Invasive Fungal Infections in Patients at High Risk in Switzerland

et al. 2010

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Objective: To evaluate the cost-effectiveness of posaconazole versus standard azoles in the prevention of invasive fungal infection (IFI) in high-risk patients, using a pharmacoeconomic model that was adapted to a Swiss setting. Methods: Decision tree models based on the results of two registration trials and subsequent Markov models over patient lifetimes were developed for patients with acute myelogenous leukemia (AML) or myelodysplastic syndrome (MDS) with neutropenia and for hematopoietic stem cell transplant recipients with graft-versus-host disease (GVHD). Results: By reducing IFIs in AML/MDS patients with posaconazole prophylaxis, the contained IFI-related treatment costs more than compensated for the incremental cost of posaconazole, resulting in savings of CHF 1,118 per patient. Lifetime posaconazole prophylaxis resulted in a benefit of 0.16 life years saved per patient compared with fluconazole/itraconazole. In patients with GVHD, posaconazole prophylaxis prevented 0.04 IFIs, resulting in incremental costs of CHF 7,040 per patient. Lifetime posaconazole prophylaxis resulted in a benefit of 0.15 life years saved per patient, with an incremental cost-effectiveness rate of CHF 48,324 per life year saved. Conclusions: Given the conditions of the Swiss setting, posaconazole can be considered a cost-effective early treatment strategy that increases survival in patients at risk for IFI and may have a substantial benefit for the economic burden of IFI.

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Section: Discussionmentioning

confidence: 99%

Cost-Effectiveness of Posaconazole Compared with Standard Azole Therapy for Prevention of Invasive Fungal Infections in Patients at High Risk in Switzerland

et al. 2010

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“…Based upon these results, Stam et al developed a predictive model of the average costs of the procedure and ascertained that prophylaxis with posaconazole appeared to be less expensive than with fluconazoleif the reduced incidence of IFI was taken into account. [47] With this in mind, our focus reverts to the other hospitalization costs since no difference was noted between the two groups in terms of prophylaxis cost. This appears to be directly related to the high cost of empirical treatment.…”

Section: Discussionmentioning

confidence: 99%

Impact of fluconazole versus posaconazole prophylaxis on the incidence of fungal infections in patients receiving induction chemotherapy for acute myeloid leukemia

et al. 2015

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F ungal infections are related to human communal agents or to environmental saprophytes and are rare in healthy subjects. Known contributing factors are reduced defense mechanisms of the host, the use of certain Background: Invasive fungal infections (IFIs) remain one of the worrying complications in patients with acute myeloid leukemia (AML) due to their incidence and high level of attributable mortality. In light of these risks, antifungal prophylaxis has always been debated. We conducted a single-center retrospective study of two prophylactic antifungal agents (fluconazole/posaconazole) in 91 consecutive patients receiving induction chemotherapy for AML between 2005 and 2009, in order to evaluate the impact on the incidence of IFI and on the mycological flora of the patients. Methods:In total, 39 patients received prophylactic fluconazole versus 52 who received posaconazole. The baseline characteristics of the two groups were comparable. Results:Overall, 17 patients developed an IFI, with no difference in frequency between the two groups. Utilization of empirical or pre-emptive therapy was similar irrespective of the type of prophylaxis used. Mycological examination of stools revealed an increase in non-albicans Candida colonization in the fluconazole group during hospitalization and the appearance of Saccharomyces cerevisiae colonization in patients receiving posaconazole. Conclusion: The present study does no t distinguish between fluconazole and posaconazole as a primary effective prevention against fungal infections. More prospective studies and meta-analyses are warranted. (Biomed J 2015;38:235-243)

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“…In all studies, utilizing posaconazole for the prophylaxis of IFIs decreased overall costs compared with fluconazole or itraconazole despite the higher medication acquisition cost. [43][44][45] While pharmacy costs tended to be much higher, the cost-avoidance came from decreasing IFIs and their extraordinarily high associated treatment costs.…”

Section: Pharmacoeconomic Analyses Of Prophylaxismentioning

confidence: 99%

Prophylaxis of Invasive Fungal Infections: A Review of the Use of Posaconazole

Collins

Smith

Kaul

2009

Clinical Medicine. Therapeutics

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Invasive fungal infections (IFIs) cause significant morbidity, mortality, and increased cost of care in patients with hematological malignancies, prolonged (i.e. 7-10 days) treatment induced neutropenia, and other disease states causing underlying immunosuppression. One strategy often used to combat the development of invasive infections is the use of antifungal agents as prophylaxis in at risk patients. Posaconazole is an oral triazole with a useful spectrum of activity against many fungal pathogens of concern in patients at risk for the development of IFIs. Posaconazole is only available in oral formulation and therapeutic drug monitoring may provide value due to variable absorption and serum concentrations. Clinical efficacy and pharmacoeconomic data have demonstrated the utility of posaconazole in the treatment of oropharyngeal candidiasis and for prophylaxis in patients at risk for development of IFIs. Several organizations or expert groups involved in developing guidelines for the management of IFIs recommend posaconazole anti-fungal prophylaxis in patients with AML or MDS and chemotherapy induced neutropenia or significant GVHD. In addition, nonrandomized studies (largely of salvage therapy) and case series suggest that posaconazole may be effective as treatment for invasive aspergillosis, zygomycosis, and coccidiomycosis. Further, small case series or individual case reports suggest activity against other less commonly encountered filamentous fungi and Histoplasma.

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

Abstract: Given the underlying data and assumptions, the economic evaluation demonstrated that posaconazole prophylaxis is expected to be cost-effective compared with fluconazole/itraconazole in neutropenic AML/MDS patients after intensive chemotherapy.

Cited by 48 publications

References 27 publications

Cost-Effectiveness of Posaconazole Compared with Standard Azole Therapy for Prevention of Invasive Fungal Infections in Patients at High Risk in Switzerland

Cost-Effectiveness of Posaconazole Compared with Standard Azole Therapy for Prevention of Invasive Fungal Infections in Patients at High Risk in Switzerland

Impact of fluconazole versus posaconazole prophylaxis on the incidence of fungal infections in patients receiving induction chemotherapy for acute myeloid leukemia

Prophylaxis of Invasive Fungal Infections: A Review of the Use of Posaconazole

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