Posaconazole vs fluconazole or itraconazole for prevention of invasive fungal diseases in patients with acute myeloid leukemia or myelodysplastic syndrome: a cost-effectiveness analysis in an Asian teaching hospital

Figures & data

Figure 1. Structure of decision tree model of posaconazole vs fluconazole or itraconazole for the prevention of IFD among a high-risk neutropenic population.

Table 1. Model parameters adopted.

Model parameters	Mean	SD	Distribution	Data reference
Efficacy of prophylaxis
Probability of IFD with fluconazole/itraconazole	0.11	0.0181	Beta	Cornely et al.15
Probability of IFD with posaconazole	0.05	0.012	Beta	Cornely et al.15
Survival following prophylaxis
Probability of death due to IFD, scenario 1^a	0.45	0.0718	Beta	Cornely et al.15
Probability of death due to IFD, scenario 2^b	0.36–0.48			O’Sullivan et al.8
Probability of other death within 100 days	0.16	0.0148	Beta	Cornely et al.15
5-year relative survival for AML after 100 days^c	0.21	–	–	SEER16
5-year relative survival for MDS after 100 days^d	0.08	–	–	Kantarjian et al.17
Costs (2012, in Hong Kong dollars)
Mean IFD treatment cost	76,469	–	–	HK HA Pharmacy
Posaconazole	558	–	–
Fluconazole	7.20	–	–
Itraconazole	132	–	–
Patients receiving fluconazole/itraconazole	95%	–	–	Queen Mary Hospital
Mean duration of prophylaxis (days)
Posaconazole	28.9	2.8	Gamma	Cornely et al.15
Fluconazole	24.9	2.4	Gamma	Cornely et al.15
Itraconazole	24.9	2.4	Gamma	Cornely et al.15
Discount rate	3%	–	Gamma	Gold et al.18

IFD, invasive fungal diseases; AML, acute myeloid leukemia; MDS, myelodysplastic syndromes.

^aScenario 1, assuming the same probability of IFD-related death for posaconazole and fluconazole/itraconazole.

^bScenario 2, assuming a different probability of IFD-related death for posaconazole (36%) vs fluconazole/itraconazole (48%).

^cAge-adjusted 5-year survival for AML according to published data from the National Cancer Institute’s Surveillance, Epidemiology, and End Results (SEER) registry16.

^dAge-adjusted 5-year survival for MDS according to a long-term follow-up study of intensive chemotherapy regimens among patients with MDS17.

Relative survival rates were weighted by the proportions of patients assumed to have AML (86%) and MDS (14%).

Table 2. Cost-effectiveness of posaconazole vs fluconazole/itraconazole in the prevention of invasive fungal diseases (IFD) among high-risk neutropenic patients based on two scenarios.

Results of analysis of 100-day clinical trial period per patient
Treatment	Drug costs*	IFD treatment costs*	Total costs*	Incremental costs*	IFD events	IFD events avoided
Scenario 1
Fluconazole/itraconazole	3131	8412	11,543	–	0.110	–
Posaconazole	16,126	3503	19,629	8086	0.046	0.064
Scenario 2
Fluconazole/itraconazole	3131	8412	11,543	–	0.11	–
Posaconazole	16,126	3503	19,629	8086	0.046	0.064
Results of analysis of lifetime model per patient
	‘Tree’ cost*	AML treatment cost*	Total cost*	Incremental costs*	Life years	Life years saved
Scenario 1
Fluconazole/itraconazole	11,543	0.00	11,543	–	2.45	–
Posaconazole	19,629	0.00	19,629	8086	2.52	0.07
Scenario 2
Fluconazole/itraconazole	11,543	0.00	11,543	–	2.44	–
Posaconazole	19,629	0.00	19,629	8086	2.53	0.090

*All costs are in Hong Kong dollars.

Figure 2. Scatter-plot of 1000 incremental cost and incremental life-year pairs for posaconazole vs fluconazole or itraconazole according to scenario 1, which assumed that there was no difference in mortality associated with IFD in different prophylactic groups. PSA, probabilistic sensitivity analysis; ICER, incremental cost-effectiveness ratio; LYS, life-years saved.

Figure 3. Scatter-plot of 1000 incremental cost and incremental life-year pairs for posaconazole vs fluconazole or itraconazole according to scenario 2, which assumed that there was a lower mortality associated with IFD in the posaconazole group as compared with the fluconazole/itraconazole group, according to published results9. PSA, probabilistic sensitivity analysis; ICER, incremental cost-effectiveness ratio; LYS, life-years saved.

Figure 4. Probablitiy that posaconazole was cost-effective vs fluconazole or itraconazole for the prevention of IFD according to scenario 1, which assumed that there was no difference in mortality associated with IFD in different prophylactic groups. CEAC, cost-effectiveness acceptability curve; LYS, life-years saved; POS, posaconazole.

Figure 5. Probability that posaconazole was cost-effective vs fluconazole or itraconazole for the prevention of IFD according to scenario 2, which assumed that there was a lower mortality associated with IFD in the posaconazole group as compared with the fluconazole/itraconazole group, according to published results9. CEAC, cost-effectiveness acceptability curve; LYS, life-years saved; POS, posaconazole.

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