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Pharmacoeconomic evaluation of voriconazole vs. liposomal amphotericin B in empiric treatment of invasive fungal infections in Turkey.

Turner SJ, Senol E, Kara A, Al-Badriyeh D, Dinleyici EC, Kong DC - BMC Infect. Dis. (2013)

Bottom Line: Decision analytic modelling was used to create a pathway for patient treatment with a 5-point composite outcome measure.Removing fever resolution as part of the composite outcome measure resulted in voriconazole being the preferred alternative per successfully treated patient.Monte Carlo Simulation resulted in 69.4% of simulations favouring voriconazole per patient treated.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Pediatrics, Pediatric Intensive Care and Pediatric Infectious Disease, Faculty of Medicine, Eskisehir Osmangazi University, Eskisehir 26480, Turkey. timboothtr@yahoo.com.

ABSTRACT

Background: Invasive fungal infections (IFI) are associated with considerable expense and mortality on healthcare systems. There is a need to provide evidence of both clinical efficacy and value for money with any health technology. The current pharmacoeconomic evaluation investigated the use of liposomal amphotericin B (LAmB) and voriconazole for the empiric treatment of IFI in the Turkish setting.

Methods: Decision analytic modelling was used to create a pathway for patient treatment with a 5-point composite outcome measure. The data was obtained from a major non-inferiority multicentre randomised controlled study, with an expert panel of clinicians in Turkey providing transition probabilities and cost not available in the literature. Sensitivity analyses were performed on the inputs from the clinical trial and the expert panel.

Results: As per the base case analysis, voriconazole was preferred by Turkish Lira (TL) 2,523 per patient treated and TL2,520 per surviving patient. LAmB was the preferred alternative by TL5,362 per successfully treated patient. Removing fever resolution as part of the composite outcome measure resulted in voriconazole being the preferred alternative per successfully treated patient. Univariate sensitivity analysis highlighted that increasing the duration of voriconazole by >1.2 days or decreasing LAmB by >1.0 days changes the result. Monte Carlo Simulation resulted in 69.4% of simulations favouring voriconazole per patient treated.

Conclusion: There is a strong likelihood that voriconazole is economically more favourable than LAmB in the empiric treatment of IFI in Turkey.

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Related in: MedlinePlus

Decision tree for the empiric treatment of IFI with voriconazole or liposomal amphotericin B in adult febrile neutropaenic patients.
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Figure 1: Decision tree for the empiric treatment of IFI with voriconazole or liposomal amphotericin B in adult febrile neutropaenic patients.

Mentions: The decision-analytic tree outlining the usual treatment algorithm for patients receiving either voriconazole or LAmB was based on work of Al-Badriyeh et al.[10] This tree (Figure 1) allowed for 8 distinct patient outcomes stratified on the presence or absence of a baseline fungal infection; incorporating the 5-point composite outcome measure previously referenced. Those patients with no baseline fungal infection will fall into branches describing either successful treatment from the antifungal agent chosen, or failure resulting in either mortality or distinct outcomes requiring a transition to an alternative agent (breakthrough fungal infection, premature discontinuation or persistent fever). Patients with a baseline fungal infection are described by 3 branches viz. successful treatment, failure resulting in mortality or a persistent baseline fungal infection necessitating a transition to an alternative antifungal agent.


Pharmacoeconomic evaluation of voriconazole vs. liposomal amphotericin B in empiric treatment of invasive fungal infections in Turkey.

Turner SJ, Senol E, Kara A, Al-Badriyeh D, Dinleyici EC, Kong DC - BMC Infect. Dis. (2013)

Decision tree for the empiric treatment of IFI with voriconazole or liposomal amphotericin B in adult febrile neutropaenic patients.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4222893&req=5

Figure 1: Decision tree for the empiric treatment of IFI with voriconazole or liposomal amphotericin B in adult febrile neutropaenic patients.
Mentions: The decision-analytic tree outlining the usual treatment algorithm for patients receiving either voriconazole or LAmB was based on work of Al-Badriyeh et al.[10] This tree (Figure 1) allowed for 8 distinct patient outcomes stratified on the presence or absence of a baseline fungal infection; incorporating the 5-point composite outcome measure previously referenced. Those patients with no baseline fungal infection will fall into branches describing either successful treatment from the antifungal agent chosen, or failure resulting in either mortality or distinct outcomes requiring a transition to an alternative agent (breakthrough fungal infection, premature discontinuation or persistent fever). Patients with a baseline fungal infection are described by 3 branches viz. successful treatment, failure resulting in mortality or a persistent baseline fungal infection necessitating a transition to an alternative antifungal agent.

Bottom Line: Decision analytic modelling was used to create a pathway for patient treatment with a 5-point composite outcome measure.Removing fever resolution as part of the composite outcome measure resulted in voriconazole being the preferred alternative per successfully treated patient.Monte Carlo Simulation resulted in 69.4% of simulations favouring voriconazole per patient treated.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Pediatrics, Pediatric Intensive Care and Pediatric Infectious Disease, Faculty of Medicine, Eskisehir Osmangazi University, Eskisehir 26480, Turkey. timboothtr@yahoo.com.

ABSTRACT

Background: Invasive fungal infections (IFI) are associated with considerable expense and mortality on healthcare systems. There is a need to provide evidence of both clinical efficacy and value for money with any health technology. The current pharmacoeconomic evaluation investigated the use of liposomal amphotericin B (LAmB) and voriconazole for the empiric treatment of IFI in the Turkish setting.

Methods: Decision analytic modelling was used to create a pathway for patient treatment with a 5-point composite outcome measure. The data was obtained from a major non-inferiority multicentre randomised controlled study, with an expert panel of clinicians in Turkey providing transition probabilities and cost not available in the literature. Sensitivity analyses were performed on the inputs from the clinical trial and the expert panel.

Results: As per the base case analysis, voriconazole was preferred by Turkish Lira (TL) 2,523 per patient treated and TL2,520 per surviving patient. LAmB was the preferred alternative by TL5,362 per successfully treated patient. Removing fever resolution as part of the composite outcome measure resulted in voriconazole being the preferred alternative per successfully treated patient. Univariate sensitivity analysis highlighted that increasing the duration of voriconazole by >1.2 days or decreasing LAmB by >1.0 days changes the result. Monte Carlo Simulation resulted in 69.4% of simulations favouring voriconazole per patient treated.

Conclusion: There is a strong likelihood that voriconazole is economically more favourable than LAmB in the empiric treatment of IFI in Turkey.

Show MeSH
Related in: MedlinePlus