Cost-effectiveness of primary antifungal prophylaxis with posaconazole versus itraconazole in allogeneic hematopoietic stem cell transplantation

Figures & data

Table 1. Clinical data from observational study15.

	Posaconazole (n = 33)	Itraconazole (n = 16)	p-value
Fever, n (%)	27 (81.8)	14 (87.5)	NS
Persistent fever (≥72 h), n (%)	8 (24.2)	5 (31.3)	NS
Prophylaxis maintenance for fixed 100-day period, n (%)	27 (81.8)	11 (68.8)	NS
Time, in days, to empiric therapy initiation, median (range)	23.5 (15–54)	10 (4–37)	NS
Incidence of proven/probable IFI,^a n (%)	0 (0)	2 (12.5)	0.04
IFI-free survival, 100 days, n (%)	30 (90.9)	9 (56.3)	0.003
Overall survival, 100 days, n (%)	30 (90.9)	10 (62.5)	0.011

IFI, invasive fungal infection; NS, not significant.

^aAccording to the 2008 criteria of the European Organization for Research and Treatment of Cancer (EORTC)20.

Table 2. Incidence of grade III or IV^a antifungal drug toxicities, n (%), from observational study15.

Week	Posaconazole (n = 33)				Itraconazole (n = 16)
	Bili	ALT	Alk Phos	GGT	Bili	ALT	Alk Phos	GGT
0	0	1 (3.0)	0	7 (21.2)	1 (6.1)	0	0	0
1	0	0	0	10 (30.3)	1 (6.1)	0	0	1 (6.1)
2	2 (6.1)	0	0	9 (27.3)	1 (6.1)	0	0	1 (6.1)
4	1 (3.0)	1 (3.0)	1 (3.0)	11 (33.3)	4 (25.0)	2 (12.5)	0	2 (12.5)
9	1 (3.0)	1 (3.0)	0	10 (30.3)	1 (6.1)	2 (12.5)	0	3 (18.8)
14	0	0	0	7 (21.2)	1 (6.1)	2 (12.5)	0	5 (31.3)

Alk Phos, alkaline phosphatase; ALT, alanine transaminase; Bili, bilirubin; GGT, gamma-glutamyltransferase.

^a National Cancer Institute Common Terminology Criteria for Adverse Events, version 3.021.

Figure 1. Total treatment costs (€) per patient up to 100 days after transplantation.

Table 3. Costs of healthcare resources considered in the cost-effectiveness analysis.

Healthcare resource	Cost, €^a
Stay/day
Hematology unit	456.37
Intensive care unit	1270.80
Imaging procedures
X-ray examination	20.65
Ultrasonography	69.24
Computed tomography	174.22
Testing
Biochemistry	14.73
Hemogram	13.42
Cerebrospinal fluid biochemistry	36.40
Fungus identification methods
Blood culture	24.77
Sputum microculture	22.13
Stool culture	19.17
Urine culture	17.99
Galactomannan antigen detection (ELISA)	17.51
Other
Blood smear from a central venous catheter	17.72
Bronchial aspiration	20.73
Cytomegalovirus detection	79.33
Packed red blood cell transfusion	97.46
Platelet transfusion	238.19

ELISA, enzyme-linked immunosorbent assay.

^a2008 euro value.

Figure 2. Acceptability curve presenting, for each possible threshold on the ICER, the probability that the ICER is acceptable. ICER indicates incremental cost-effectiveness ratio. Assuming a threshold of €30,000 per life-year gained, the ICER based on life-years gained is acceptable, with 75% certainty.

Figure 3. Representation of the uncertainty in differential mean costs and effectiveness showing 1000 bootstrap replications, with 95% bias-corrected confidence intervals.

Sanchez-Ortega I, Patino B, Arnan M, et al. Clinical efficacy and safety of primary antifungal prophylaxis with posaconazole vs itraconazole in allogeneic blood and marrow transplantation. Bone Marrow Transplant 2011;46:733–9

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