Limits...
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.

Show MeSH

Related in: MedlinePlus

Acceptability curves for the base case and the 15% IFI background risk scenarios, representing the probability that posaconazole is cost-effective in comparison to fluconazole for different values of willingness to pay for a QALY
© Copyright Policy
Related In: Results  -  Collection


getmorefigures.php?uid=PMC2908442&req=5

Fig2: Acceptability curves for the base case and the 15% IFI background risk scenarios, representing the probability that posaconazole is cost-effective in comparison to fluconazole for different values of willingness to pay for a QALY

Mentions: In Fig. 2, the probability that posaconazole is cost-effective relative to fluconazole is presented for different WTP ratios. Considering a WTP threshold of €50,000 per QALY, there is a 79% probability that posaconazole is cost-effective in comparison to fluconazole.Fig. 2


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)

Acceptability curves for the base case and the 15% IFI background risk scenarios, representing the probability that posaconazole is cost-effective in comparison to fluconazole for different values of willingness to pay for a QALY
© Copyright Policy
Related In: Results  -  Collection

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

Fig2: Acceptability curves for the base case and the 15% IFI background risk scenarios, representing the probability that posaconazole is cost-effective in comparison to fluconazole for different values of willingness to pay for a QALY
Mentions: In Fig. 2, the probability that posaconazole is cost-effective relative to fluconazole is presented for different WTP ratios. Considering a WTP threshold of €50,000 per QALY, there is a 79% probability that posaconazole is cost-effective in comparison to fluconazole.Fig. 2

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