Cost effectiveness of posaconazole in the prophylaxis of invasive fungal infections in acute leukaemia patients for the French healthcare system

Abstract

Background:

Acute myeloblastic leukaemia (AML) patients are at high risk of suffering from invasive fungal infections (IFI). Posaconazole demonstrated higher efficacy than standard azole agents (SAA) in the prophylaxis of IFI in this population.

The authors estimated the cost effectiveness of posaconazole versus SAA in France.

Methods:

A decision-tree model was developed to compare posaconazole with SAA with the results of a published clinical trial. Clinical events were modelled with chance nodes reflecting probabilities of IFI, IFI-related death, and death from other causes. Medical resource consumption and costs were obtained from results of the clinical trial and from a dedicated survey on the costs of treating IFI using a retrospective chart review design.

Results:

IFI treatment costs were estimated using medical files from 50 AML patients from six French centres, with a proven and probable IFI, who had been followed-up for 298 days on average. Direct costs directly related to IFI were estimated at €51,033, including extra costs of index hospitalisation, costs of antifungal therapy and additional hospitalisations related to IFI treatment. The model indicated that the healthcare costs for the posaconazole strategy were €5,223 (€2,697 for prophylaxis and €2,526 for IFI management), which was €859 less than the €6,083 in costs with SAA (€469 for prophylaxis and €5614 for IFI management). A sensitivity analysis indicated that there was an 80% probability that prophylaxis using the posaconazole strategy would be superior.

Conclusion:

The findings from this analysis suggest that posaconazole use is a clinically and economically dominant strategy in the prophylaxis of IFI in AML patients, given the usual limits of economic models and the uncertainty of costs estimates.

Key words::

• Acute leukaemia
• Cost Analysis
• Fungal infection
• Posaconazole
• Prophylaxis

Transparency

Declaration of funding:

This study was supported by Schering Plough.

Declaration of financial/other interests:

M.M., P.M. and P.B. have disclosed that they has no relevant financial relationships to disclose. D.C. has disclosed that he has been a consultant for Pfizer and Shering-Plough. B.D. has disclosed that he has received honoraria, grants and was member of speakers’ bureaus for Gilead, MSD, Schering-Plough, Astellas.

P.R. was a member of speakers' bureaus for Schering-Plough, MSD, Pfizer and Gilead.

R.H. has disclosed that he was a consultant for Astellas, Gilead, MSD, Pfizer, Schering-Plough and has been a member of speakers’ bureaus for Gilead, Pfizer, Schering-Plough and has received research grant from Pfizer. J.P. has disclosed that he has received research funding from Gilead, MSD, Pfizer and Schering Plough. A.L. has disclosed that he is an employee of Cemka Eval, a company that received funding from Schering Plough to conduct this study. A.K.O. has disclosed that she is employed by i3 Innovus, another company that received funding from Schering Plough to help conduct this study.