Cost-effectiveness of posaconazole tablets versus fluconazole as prophylaxis for invasive fungal diseases in patients with graft-versus-host disease after allogeneic hematopoietic stem cell transplantation

Santiago Grau, Rafael Cámara (), Manuel Jurado, Jaime Sanz, Belén Aragón and Irmina Gozalbo
Additional contact information
Santiago Grau: Del Mar Hospital
Rafael Cámara: La Princesa Hospital
Manuel Jurado: Virgen de las Nieves University Hospital
Jaime Sanz: La Fe University Hospital
Belén Aragón: Merck Sharp & Dohme Corp.
Irmina Gozalbo: Outcomes10

The European Journal of Health Economics, 2018, vol. 19, issue 4, No 12, 627-636

Abstract: Abstract Background The cost-effectiveness of posaconazole oral suspension versus fluconazole capsules for the prophylaxis of invasive fungal diseases (IFDs) in immunosuppressed allogeneic hematopoietic stem cell transplantation (HSCT) recipients has already been proven. Now, a new solid oral tablet formulation for posaconazole has been developed with improved bioavailability, allowing a reduced daily dosage that can be taken independently of food intake. However, the efficacy of this new formulation should be evaluated since it is associated with a higher cost than the posaconazole oral suspension. Objectives To evaluate the cost-effectiveness of solid oral tablets of posaconazole versus fluconazole capsules for the prophylaxis of IFDs in allogeneic HSCT recipients with graft-versus-host disease (GVHD) in Spain. Methodology A mathematical model comparing the efficacy and costs of posaconazole versus fluconazole was adapted to the Spanish National Healthcare System. Clinical data were obtained from the pivotal clinical trial of posaconazole oral suspension for allogeneic HSCT recipients, while pharmacological costs and use of resources were obtained from national sources. Deterministic and probabilistic sensitivity analyses (PSA), as well as two alternative scenarios, were run to evaluate the robustness of the results under varying input values. Results Posaconazole tablets reduced the number of IFD events and enhanced overall survival, while maintaining a controlled budget. When compared to fluconazole, it was found to be a cost-effective alternative, with an incremental cost-effectiveness ratio of €13,193/life years gained. The PSA showed that posaconazole remained cost-effective in 74.6% of the cases, while alternatives scenarios yielded similar results as the base case. Conclusions Posaconazole tablets are a cost-effective alternative to fluconazole and may show better results than the oral suspension formulation.

Keywords: Posaconazole; Invasive fungal disease; Invasive fungal infection; Prophylaxis; Graft-versus-host disease; Cost-effectiveness (search for similar items in EconPapers)
JEL-codes: I11 (search for similar items in EconPapers)
Date: 2018
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DOI: 10.1007/s10198-017-0907-5

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