SEIFEM 2010-E: economic evaluation of posaconazole for antifungal prophylaxis in patients with acute myeloid leukemia receiving induction chemotherapy

Abstract

Posaconazole demonstrated clinical superiority over fluconazole and itraconazole for prophylaxis of mold infections, although concerns exist regarding the high acquisition cost for posaconazole. In this respect, we sought to analyze the costs of antifungal prophylaxis in patients with acute myeloid leukemia (AML) who received prophylactic posaconazole (n = 510, 58%), itraconazole (n = 120, 14%) or fluconazole (n = 175, 20%) during induction chemotherapy. The estimated cost of antifungal prophylaxis as well as the costs of subsequent systemic antifungal therapy for treatening an invasive fungal infections (IFI) was higher in the posaconazole group compared to itraconazole and fluconazole groups. Based on the Monte Carlo simulations, the itraconazole group had the highest cost, followed by the posaconazole and fluconazole group, although the overall survival was higher in the posaconazole group as compared to the other groups. In conclusion, the cost of prophylaxis with posaconazole in AML patients compares favorably with conventional antifungal agents.

Keywords:

• Antifungal prophylaxis
• antifungal treatment
• acute myeloid leukemia
• cost

Disclosure statement

A.B. has received honoraria from Gilead Sciences, Merck, Pfizer Pharmaceuticals, Basilea, Jazz Pharmaceuticals; he has been speaker for Gilead Sciences, Merck, Pfizer Pharmaceuticals, Astellas Pharma; A.C. is a consultant/speaker Gilead, Merck, Pfizer, Celgene, Janssen; S.C. has received fee for lectures by Merck and Astellas Pharma, and fee attendance for Advisory Board by Gilead Sciences; M.D. is a consultant/speaker Gilead, Merck, Pfizer, Sanofi; R.F. is a consultant/speaker Merck; L.P. is funding and consultancies Gilead Sciences, Pfizer Pharmaceuticals and Merck; A.N. is a consultant Gilead Sciences, speaker for Gilead Sciences and Merck; F.A. is a consultant/speaker Merck, Gilead Sciences, Pfizer, Astellas and Sigma Tau; L.P. has received honoraria from Gilead Sciences, Jannsen, Merck, Pfizer Pharmaceuticals and Basilea; he has been speaker for Gilead Sciences, Merck an Basilea.

Potential conflict of interest

Disclosure forms provided by the authors are available with the full text of this article online at http://dx.doi.org/10.1080/10428194.2017.1318438.