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Economic evaluation of posaconazole versus fluconazole prophylaxis in patients with graft-versus-host disease (GVHD) in the Netherlands.

Jansen JP, O'Sullivan AK, Lugtenburg E, Span LF, Janssen JJ, Stam WB - Ann. Hematol. (2010)

Bottom Line: Posaconazole prophylaxis resulted in 0.17 (0.02-0.36) quality adjusted life year (QALY) gained compared to fluconazole prophylaxis, corresponding to an incremental cost effectiveness ratio (ICER) of <euro>26,225 per QALY gained.A scenario analysis demonstrated that at an increased background IFI risk (from 9% to 15%) the ICER was <euro>13,462 per QALY.The cost-effectiveness of posaconazole depends on the IFI risk, which can vary by hospital.

View Article: PubMed Central - PubMed

Affiliation: Mapi Values, 133 Portland Street, Boston, MA 02114, USA. Jeroen.jansen@mapivalues.com

ABSTRACT
The objective of this study was to evaluate the cost-effectiveness of posaconazole versus fluconazole for the prevention of invasive fungal infections (IFI) in graft-versus-host disease (GVHD) patients in the Netherlands. A decision analytic model was developed based on a double-blind randomized trial that compared posaconazole with fluconazole antifungal prophylaxis in recipients of allogeneic HSCT with GVHD who were receiving immunosuppressive therapy (Ullmann et al., N Engl J Med 356:335-347, 2007). Clinical events were modeled with chance nodes reflecting probabilities of IFIs, IFI-related death, and death from other causes. Data on life expectancy, quality-of-life, medical resource consumption, and costs were obtained from the literature. The total cost with posaconazole amounted to 9,428 (95% uncertainty interval 7,743-11,388), which is 4,566 (2,460-6,854) more than those with fluconazole. Posaconazole prophylaxis resulted in 0.17 (0.02-0.36) quality adjusted life year (QALY) gained compared to fluconazole prophylaxis, corresponding to an incremental cost effectiveness ratio (ICER) of 26,225 per QALY gained. A scenario analysis demonstrated that at an increased background IFI risk (from 9% to 15%) the ICER was 13,462 per QALY. Given the underlying data and assumptions, posaconazole prophylaxis is expected to be cost-effective relative to fluconazole in recipients of allogeneic HSCT developing GVHD in the Netherlands. The cost-effectiveness of posaconazole depends on the IFI risk, which can vary by hospital.

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Decision analytic model for cost-effectiveness evaluation of posaconazole versus fluconazole for prophylaxis of fungal infections. * survival beyond 112 days was extended with 1-month Markov cycles (M)
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Fig1: Decision analytic model for cost-effectiveness evaluation of posaconazole versus fluconazole for prophylaxis of fungal infections. * survival beyond 112 days was extended with 1-month Markov cycles (M)

Mentions: A decision analytic model was developed (Fig. 1) to estimate the cost-effectiveness of orally administered posaconazole (600 mg/day) versus standard fluconazole (400 mg/day) in patients with GVHD following HSCT treated with intensive immunosuppressive therapy. In line with the RCT by Ullmann et al. [11], the average age of patients was 40 years. Although the trial population consisted of 65% males, the model assumed an equal distribution of males and females because for the majority of source data used in the economic evaluation, only estimates for the total population (based on about 50% males and 50% females) were available. Consistent with the duration of the trial, clinical events during the first 112 days were modeled with a decision tree consisting of chance nodes reflecting the probability of a proven or probable IFI according to international consensus criteria, IFI related death, and death from other causes associated with posaconazole and fluconazole (see Fig. 1). The results of the 112-day trial were extrapolated to lifetime expected outcomes using a Markov state-transition structure consisting of repeated Markov cycles of 1 month. This allows for the estimation of the number of life years (LY) and quality adjusted life years (QALY) among patients that survived the prophylactic period. It was assumed that patients who survived an IFI during the prophylactic period displayed a monthly mortality rate similar to patients who did not experience an IFI.Fig. 1


Economic evaluation of posaconazole versus fluconazole prophylaxis in patients with graft-versus-host disease (GVHD) in the Netherlands.

Jansen JP, O'Sullivan AK, Lugtenburg E, Span LF, Janssen JJ, Stam WB - Ann. Hematol. (2010)

Decision analytic model for cost-effectiveness evaluation of posaconazole versus fluconazole for prophylaxis of fungal infections. * survival beyond 112 days was extended with 1-month Markov cycles (M)
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC2908442&req=5

Fig1: Decision analytic model for cost-effectiveness evaluation of posaconazole versus fluconazole for prophylaxis of fungal infections. * survival beyond 112 days was extended with 1-month Markov cycles (M)
Mentions: A decision analytic model was developed (Fig. 1) to estimate the cost-effectiveness of orally administered posaconazole (600 mg/day) versus standard fluconazole (400 mg/day) in patients with GVHD following HSCT treated with intensive immunosuppressive therapy. In line with the RCT by Ullmann et al. [11], the average age of patients was 40 years. Although the trial population consisted of 65% males, the model assumed an equal distribution of males and females because for the majority of source data used in the economic evaluation, only estimates for the total population (based on about 50% males and 50% females) were available. Consistent with the duration of the trial, clinical events during the first 112 days were modeled with a decision tree consisting of chance nodes reflecting the probability of a proven or probable IFI according to international consensus criteria, IFI related death, and death from other causes associated with posaconazole and fluconazole (see Fig. 1). The results of the 112-day trial were extrapolated to lifetime expected outcomes using a Markov state-transition structure consisting of repeated Markov cycles of 1 month. This allows for the estimation of the number of life years (LY) and quality adjusted life years (QALY) among patients that survived the prophylactic period. It was assumed that patients who survived an IFI during the prophylactic period displayed a monthly mortality rate similar to patients who did not experience an IFI.Fig. 1

Bottom Line: Posaconazole prophylaxis resulted in 0.17 (0.02-0.36) quality adjusted life year (QALY) gained compared to fluconazole prophylaxis, corresponding to an incremental cost effectiveness ratio (ICER) of <euro>26,225 per QALY gained.A scenario analysis demonstrated that at an increased background IFI risk (from 9% to 15%) the ICER was <euro>13,462 per QALY.The cost-effectiveness of posaconazole depends on the IFI risk, which can vary by hospital.

View Article: PubMed Central - PubMed

Affiliation: Mapi Values, 133 Portland Street, Boston, MA 02114, USA. Jeroen.jansen@mapivalues.com

ABSTRACT
The objective of this study was to evaluate the cost-effectiveness of posaconazole versus fluconazole for the prevention of invasive fungal infections (IFI) in graft-versus-host disease (GVHD) patients in the Netherlands. A decision analytic model was developed based on a double-blind randomized trial that compared posaconazole with fluconazole antifungal prophylaxis in recipients of allogeneic HSCT with GVHD who were receiving immunosuppressive therapy (Ullmann et al., N Engl J Med 356:335-347, 2007). Clinical events were modeled with chance nodes reflecting probabilities of IFIs, IFI-related death, and death from other causes. Data on life expectancy, quality-of-life, medical resource consumption, and costs were obtained from the literature. The total cost with posaconazole amounted to 9,428 (95% uncertainty interval 7,743-11,388), which is 4,566 (2,460-6,854) more than those with fluconazole. Posaconazole prophylaxis resulted in 0.17 (0.02-0.36) quality adjusted life year (QALY) gained compared to fluconazole prophylaxis, corresponding to an incremental cost effectiveness ratio (ICER) of 26,225 per QALY gained. A scenario analysis demonstrated that at an increased background IFI risk (from 9% to 15%) the ICER was 13,462 per QALY. Given the underlying data and assumptions, posaconazole prophylaxis is expected to be cost-effective relative to fluconazole in recipients of allogeneic HSCT developing GVHD in the Netherlands. The cost-effectiveness of posaconazole depends on the IFI risk, which can vary by hospital.

Show MeSH
Related in: MedlinePlus