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

Figures & data

Table 1.  DRG of acute leukaemia hospitalizations with and without complication: tariffs and daily tariff of extra LOS15.

DRG code	Label	Tariff per DRG	Upper limit of LOS (days)	Daily cost per day over the limit
17M09V	Acute leukaemia of adult patients without complications	€8,478.27	41	€560.80
17M09W	Acute leukaemia of adult patients with complications	€15,129.56	51	€550.46

DRG, diagnosis-related group.

LOS, Length of stay.

Table 2.  Unit costs (taxes included) of antifungal agents15.

Brand name, dosage and unit	Active product	Route	Unit cost	Price per mg (€)	Drug list off DRG*
Abelcet 5 mg/ml 1 bottle of 100 mg	Liposomial amphotericin B	IV	€132.73	1.32730	Yes
Ambisome 50 mg 1 bottle of 50 mg	Liposomial amphotericin B	IV	€155.19	3.10380	Yes
Cancidas 50 mg 1 bottle of 50 mg	Caspofungine	IV	€488.04	9.76076	Yes
Cancidas 70 mg 1 bottle of 70 mg	Caspofungine	IV	€620.77	8.86811	Yes
Fungizone 50 mg 1 bottle of 50 mg	Amphotericin B	IV	€8.36	0.16720	No
Noxafil 40 mg/ml 1 bottle of 105 ml	Posaconazole	PO	€648.34	0.15437	No
Sporanox 100 mg 1 box of 30 capsules	Itraconazole	PO	€84.92	0.02831	No
Sporanox 250 mg 1 vial of 250 mg	Itraconazole	IV	€25.00	0.10000	No
Triflucan 2 mg/ml 1 bottle of 100 ml	Fluconazole	IV	€25.53	0.12765	No
Triflucan 200 mg 1 box of 30 capsules	Fluconazole	PO	€334.01	0.05567	No
Vfend 200 mg 1 tablet	Voriconazole	PO	€41.86	0.20931	No
Vfend 200 mg 1 vial	Voriconazole	IV	€158.26	0.79128	Yes
Vfend 50 mg 1 tablet	Voriconazole	PO	€10.52	0.21032	No

IV, intravenous administration; PO, oral route of administration.

*Drug registered on the list of drugs off DRG. These medications are charged on top of the DRG to the French sickness funds.

Table 3.  Parameters of the model, distribution laws, baseline value, standard deviations used in the sensitivity analyses and sources.

Parameter	Distribution type	Baseline value	SD*	Source
IFI probability in the control arm	Beta	0.1100	0.0181	Clinical trial
Relative risk of IFI for posaconazole patients	Gamma	0.4500	–	Clinical trial
IFI probability in the posaconazole arm	Beta	0.0495	0.0120	Clinical trial
Death rate due to IFI in the posaconazole arm	Beta	0.4300	0.0714	Clinical trial
Death rate due to IFI in the control arm	Beta	0.4300	0.0714	Clinical trial
Death rate due to other cause in the posaconazole arm	Beta	0.1500	0.0140	Clinical trial
Death rate due to other cause in the posaconazole arm	Beta	0.1500	0.0140	Clinical trial
Relative survival of AML patients	Gamma	0.2090	–	SEER
Relative survival of MDS patients	Gamma	0.0800	–	SEER
IFI related costs during index hospitalization	Gamma	27 497	3450	Cost study
IFI related costs after discharge	Gamma	23 536	–	Cost study
Daily cost of posaconazole	Gamma	93	–
Daily cost of fluconazole	Gamma	18	–
Daily cost of itraconazole	Gamma	22	–
% of patients treated with itraconazole in the control arm	Beta	0.1900	–	Clinical trial
Treatment duration of posaconazole (in days)	Gamma	29.0000	–	Clinical trial
Treatment duration of itraconazole (in days)	Gamma	25.0000	–	Clinical trial
Treatment duration of fluconazole (in days)	Gamma	25.0000	–	Clinical trial
Discount rate	Beta	0.03	–

*SD of certain parameters are assumed to be 0 and not included in the probabilities sensitivity analysis.

IFI, invasive fungal infection; AML, acute myeloid leukaemia; MDS, myelodysplastic syndrome.

Figure 1.  Transition probabilities and number of patients for each strategy (on the basis of 100 patients) (a) in the posaconazole group, (b) in the control group.

Figure 2.  Multivariate sensitivity analyses.

Table 4.  Results of the model according to the payer (average cost per patient).

	Posaconazole	Itraconazole/fluconazole	Difference
Prophylaxis treatment costs
Paid by hospitals	€2,023	€352	€1,671
Charged to Sickness Funds	€674	+€117	€557
Total prophylaxis treatment costs	€2,697	€469	+€2,228
IFI costs
Paid by hospitals	€45	€99	−€54
Charged to Sickness Funds	€2,481	€5,515	−€3,033
Total IFI costs	€2,526	€5,614	−€3,087
Total costs
Paid by hospitals	€2,068	451	+€1,617
Charged to Sickness Funds	€3,155	€5,632	−€2,477
Total costs	€5,223	€6,083	−€859
Life expectancy	0.74	0.72	0.02
Cost-effectiveness ratio	Dominant

IFI, invasive fungal infection.

http://www.atih.sante.fr/openfile.php?id=1819 Accessed 3 June 2009

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