Economic evaluation of isavuconazole for suspected invasive pulmonary aspergillosis in Canada

ABSTRACT

Background

Invasive mold infections (IMI) directly impact life expectancy, especially with delayed therapy. Among IMI, aspergillosis (IA) is more common than mucormycosis (IM), resulting in IA-targeted empirical treatment with voriconazole for suspected invasive pulmonary aspergillosis (IPA), despite IM ineffectiveness. Recently, isavuconazole was approved in Canada for IA and IM. The primary objective was to assess the cost-effectiveness of isavuconazole compared to voriconazole for suspected IPA in Canada. A secondary objective was to assess the impact of varying time horizons to address the wide spectrum of life expectancies, according to patients underlying diseases.

Research Design and Methods

A 5-year decision-tree was developed from the Canadian Ministry of Health (MoH) and societal perspectives. Efficacy parameters were extracted from SECURE/VITAL trials. Costs included treatment acquisition, hospitalization, adverse events and productivity loss. 3- and 10-year time horizon alternative scenarios and extensive sensitivity analyses were also conducted.

Results

From a MoH perspective, isavuconazole compared to voriconazole resulted in an incremental cost-utility ratio (ICUR) of $C30,160/QALY. 3- and10-year ICURs were also cost-effective, relative to a willingness-to-pay threshold of $C50,000/QALY.

Conclusions

This study demonstrates that, in comparison to voriconazole, isavuconazole is a cost-effective strategy for the treatment of patients with suspected IPA, regardless of their life expectancy.

KEYWORDS:

• Invasive mold infections
• invasive aspergillosis
• invasive mucormycosis
• isavuconazole
• economic evaluation
• decision tree

Acknowledgments

We would like to thank Karine Mathurin (PeriPharm Inc.) for study supervision and manuscript revision as well as Erin Hillhouse (PeriPharm Inc.) for manuscript revision.

Declaration of interest

C Beauchemin is a partner at PeriPharm, a company that has served as a consultant to AVIR Pharma Inc. and has received funding from AVIR Pharma Inc. K Guinan is an employee of PeriPharm Inc. D Claveau is an employee of AVIR Pharma Inc. S Dufresne has received personal fees from AVIR Pharma Inc., during the conduct of the study. C Rotstein has received grants from Astellas Pharma Canada and Avir Pharma Inc., during the conduct of the study. Grants from Chimerix Inc., Cidara, Pendopharm, Merck Canada Inc., Roche Pharma Canada and Sunovion Canada, outside the submitted work. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Previous Publications

No previous publications have been published for this manuscript. However, the following abstracts were presented or will be presented shortly:

• Beauchemin C Isavuconazole for the Treatment of Invasive Aspergillosis and Mucormycosis- A Canadian Cost-Utility Analysis. 23rd Annual European Congress of the International Society for Pharmacoeconomics and Outcomes Research: abstr. PIN44, 16 November 2020.

• Beauchemin C Canadian cost-utility analysis of isavuconazole for the treatment of patients with invasive aspergillosis and mucormycosis. Annual Conference AMMI Canada – CACMID, April 25-30, 2021.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Author contributions

CB is the guarantor of the article. KG was involved in study conception and design, modeling, analysis and interpretation of data, and drafting the manuscript. CB and DC were involved in study conception and design, revision of the manuscript, and study supervision. SFD and CR were involved in study conception and design and revision of the manuscript. All authors approved the final version of the manuscript and agree to be accountable for all aspects of the work.

Additional information

Funding

This paper was funded by AVIR Pharma Inc