Cost analysis of voriconazole versus liposomal amphotericin B for primary therapy of invasive aspergillosis among patients with haematological disorders in Germany and Spain

Fecha de publicación: 24/09/2014

Autores de IIS La Fe

Isidro Jarque Ramos

Autor

Participantes ajenos a IIS La Fe

Ostermann, H
Solano, C
Garcia-Vidal, C
Gao, X
Barrueta, JA
De Salas-Cansado, M
Stephens, J
Xue, M
Weber, B
Charbonneau, C

Grupos

Hematología y Hemoterapia

Investigador Principal

Javier De La Rubia Comos

Abstract

Background: The current healthcare climate demands pharmacoeconomic evaluations for different treatment strategies incorporating drug acquisition costs, costs incurred for hospitalisation, drug administration and preparation, diagnostic and laboratory testing and drug-related adverse events (AEs). Here we evaluate the pharmacoeconomics of voriconazole versus liposomal amphotericin B as first-line therapies for invasive aspergillosis (IA) in patients with haematological malignancy and prolonged neutropenia or who were undergoing haematopoietic stem-cell transplantation in Germany or Spain. Methods: A decision analytic model based on a decision tree was constructed to estimate the potential treatment costs of voriconazole versus liposomal amphotericin B. Each model pathway was defined by the probability of an event occurring and the costs of clinical outcomes. Outcome probabilities and cost inputs were derived from the published literature, clinical trials, expert panels and local database costs. In the base case, patients who failed to respond to first-line therapy were assumed to experience a single switch between comparator drugs or the other drug was added as second-line treatment. Base-case evaluation included only drug-management costs and additional hospitalisation costs due to severe AEs associated with first-and second-line therapies. Sensitivity analyses were conducted to assess the robustness of the results. Cost estimates were inflated to 2011 euros ((sic)). Results: Based on clinical trial success rates of 52.8% (voriconazole) and 50.0% (liposomal amphotericin B), voriconazole had lower total treatment costs compared with liposomal amphotericin B in both Germany ((sic)12,256 versus (sic)18,133; length of therapy [LOT] = 10-day intravenous [IV] + 5-day oral voriconazole and 15-day IV liposomal amphotericin B) and Spain ((sic)8,032 versus (sic)10,516; LOT = 7-day IV + 8-day oral voriconazole and 15-day IV liposomal amphotericin B). Assuming the same efficacy (50.0%) in first-line therapy, voriconazole maintained a lower total treatment cost compared with liposomal amphotericin B. Cost savings were primarily due to the lower drug acquisition costs and shorter IV LOT associated with voriconazole. Sensitivity analyses showed that the results were sensitive to drug price, particularly the cost of liposomal amphotericin B. Conclusions: Voriconazole is likely to be cost-saving compared with liposomal amphotericin B when used as a first-line treatment for IA in Germany and Spain.

Datos de la publicación

ISSN/ISSNe:: 2050-6511,
Tipo:: Article
Páginas:: -
DOI:: 10.1186/2050-6511-15-52
Factor de Impacto:: 0,715 SCImago ℠
Cuartil:: Q2 SCImago ℠

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Filiaciones

Ostermann, H:: Univ Hosp Munich Grosshadern, Dept Haematol & Oncol, Med Clin 3, Munich, Germany
Solano, C:: Univ Valencia, Hosp Clin Univ INCLIVA, Dept Haematol & Oncol, Valencia, Spain
Jarque, I:: Univ Hosp, Haematol Serv, Valencia, Spain

Politecn La Fe, Valencia, Spain
Garcia-Vidal, C:: Univ Barcelona, Hosp Univ Bellvitge, Barcelona, Spain
Gao, X:: Pharmerit Int, Bethesda, MD USA
Barrueta, JA:: Pfizer Spain, Med Unit, Madrid, Spain
De Salas-Cansado, M:: Pfizer Spain, Hlth Econ & Outcomes Res Dept, Madrid, Spain
Stephens, J:: Pharmerit Int, Bethesda, MD USA
Xue, M:: Pharmerit Int, Bethesda, MD USA
Weber, B:: Pfizer Germany, Hlth Technol Assessment & Outcomes Res Dept, Berlin, Germany
Charbonneau, C:: Pfizer Int Operat, Hlth Econ & Outcomes Res Dept, Paris, France