Posaconazole vs fluconazole/itraconazole in the prophylaxis of invasive fungal infections in immunocompromised patients: A cost-effectiveness analysis in Greece

Figures & data

Figure 1. The study model.

Table 1. Base case parameters.

Model Input parameters	Point estimate
Efficacy of prophylaxis
Probability of experiencing an IFI
Fluconazole/itraconazole	0.11
Relative risk associated with posaconazole	0.45
Survival following prophylaxis treatment
Probability of experiencing an IFI-related death within 100 days of initiation of prophylaxis drug therapy
Posaconazole	0.43
Fluconazole/itraconazole	0.43
Probability of death from other causes within 100 days
Posaconazole	0.15
Fluconazole/itraconazole	0.15
Natural history
Relative survival for AML patients
No IFI	0.209
With IFI	0.209
Relative survival for MDS patients
No IFI	0.08
With IFI	0.08
Costs for the Greek setting
IFI
Inpatient costs	€26,071
Drug costs (per day)
Posaconazole	€73
Fluconazole	€6
Itraconazole	€6
% of fluconazole/itraconazole patients receiving itraconazole	19%
Discount rate	3.00%

Table 2. Variables varied in the sensitivity analysis and parameters of distributions.

Variable	Distribution	Parameters
Probability of IFI fluconazole/itraconazole	Beta	α = 33, β = 265^a
Probability of IFI posaconazole	Beta	α = 14, β = 290^a
Probability of IFI related death, given IFI (both arms)	Beta	α = 20, β = 26^a
Probability of other death (both arms)	Beta	α = 97, β = 519^a
Treatment duration for posaconazole	Gamma	Mean = 28.9, SE = 1.20^a,b
Treatment duration for fluconazole/itraconazole	Gamma	Mean = 24.9, SE = 0.98^a,b
IFI treatment costs	Gamma	Mean = 26,071.16^c SE = 2193.9

Sources for the parameters of the distributions:

^aCornelly et al.14.

^bO’Sullivan et al.15.

^cCosting study (expert panel).

Table 3. Cost-effectiveness results of posaconazole vs standard azole treatment for a lifetime horizon.

Treatment arm	Total costs	Incremental costs	Life years gained	Incremental life years	ICER (€/LY saved)
Fluconazole/Itraconazole	€3015	–	0.728
Posaconazole	€3406	€391	0.744	0.016	€24,196

Table 4. Cost-effectiveness results of posaconazole vs standard azole treatment for the 100 first days of treatment.

Treatment arm	Drug costs	IFI treatment costs	Total costs	Incremental costs	IFI events	IFI events avoided	ICER ((E) per IFI avoided)
Fluconazole/Itraconazole	€147	€2868	€3015	–	0.11	–	–
Posaconazole	€2115	€1291	€3406	€391	0.05	0.061	€6455

Figure 2. Probabilistic sensitivity analysis scatterplot for posaconazole vs standard azole treatment. Trendline represents the €30,000/LYS threshold, points represent ICERs. Points that fall in the SW quadrant represent ‘dominant’ ICERs (posaconazole more effective and less costly than alternatives). Points that fall in the SW quadrant plus those that fall under the trendline represent cost-effective ICERs.

Figure 3. Cost-effectiveness acceptability curve for posaconazole vs standard azole treatment.

Cornely OA, Maertens J, Winston DJ, et al. Posaconazole versus fluconazole ore itraconazole prophylaxis in patients with neutropenia. N Engl J Med 2007;356:348–59

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O'Sullivan AK, Pandya A, Papadopoulos G, et al. Cost-effectiveness of posaconazole versus fluconazole or itraconazole in the prevention of invasive fungal infections among neutropenic patients in the United States. Value Health 2009;12:666–73

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