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Cost effectiveness of itraconazole in the prophylaxis of invasive fungal infections.

Abstract：

BACKGROUND:Invasive fungal infections in neutropenic patients treated for haematological malignancies are associated with a high mortality rate and, therefore, require early treatment. As the diagnosis of invasive fungal infections is difficult, effective antifungal prophylaxis is desirable. So far, fluconazole has been the most commonly used. OBJECTIVE:To assess the cost effectiveness of itraconazole compared with both fluconazole and no prophylaxis for the prevention of invasive fungal infections in haematological patients, mean age 51 years, in Germany and The Netherlands. STUDY DESIGN:We designed a probabilistic decision model to fully incorporate the uncertainty associated with the risk estimates of acquiring an invasive fungal infection. These risk estimates were extracted from two meta-analyses, evaluating the effectiveness of fluconazole and itraconazole and no prophylaxis. The perspective of the analysis was that of the healthcare sector; only medical costs were taken into account. All costs were reported in euro, year 2004 values.Cost effectiveness was expressed as net costs per invasive fungal infection averted. No discounting was performed, as the model followed patients during their neutropenic period, which was assumed to be less than 1 year. RESULTS:According to our probabilistic decision model, the monetary benefits of averted healthcare exceed the costs of itraconazole prophylaxis under baseline assumptions (95% CI: from cost-saving to euro 5000 per invasive fungal infection averted). Compared with fluconazole, itraconazole is estimated to be both more effective and more economically favourable, with a probability of almost 98%. CONCLUSIONS:In specific groups of neutropenic patients treated for haematological malignancies, itraconazole prophylaxis could potentially reduce overall healthcare expenditure, without harming effectiveness, in settings where fluconazole is common practice in the prophylaxis of invasive fungal infections.

journal_name

Pharmacoeconomics

journal_title

PharmacoEconomics

authors

de Vries R,Daenen S,Tolley K,Glasmacher A,Prentice A,Howells S,Christopherson H,de Jong-van den Berg LT,Postma MJ

doi

10.2165/00019053-200826010-00007

subject

Has Abstract

pub_date

2008-01-01 00:00:00

pages

75-90

issue

eissn

1170-7690

issn

1179-2027

pii

2617

journal_volume

pub_type

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Cost effectiveness of itraconazole in the prophylaxis of invasive fungal infections.