Costo Efectividad de Posaconazol versus Fluconazol/Itraconazol en el Tratamiento Profiláctico de las Infecciones Fúngicas Invasivas en México

Translated title of the contribution: Cost-effectiveness of posaconazole versus fluconazole-itraconazole in the prophylactic treatment of invasive fungal infections in Mexico

Kely Rely, Pierre K. Alexandre, Guillermo Salinas Escudero

Research output: Contribution to journalArticle

Abstract

Cost effectiveness of posaconazole versus fluconazole/itraconazole therapy in the prophylaxis against invasive fungal Infections among high-risk neutropenic patients in Mexico. Objective: To estimate the cost effectiveness and long-term combined effects of Posaconazole versus fluconazole/itraconazole (standard azole) therapy in the prophylaxis against invasive fungal Infections among high-risk neutropenic patients in Mexico. Methods: A previously validated Markov model was used to compare the projected lifetime costs and effects of two theoretical groups of patients, one receiving Posaconazole and the other receiving standard azole. The model estimates total costs, numbers of IFIs, and QALY per patient in each prophylaxis group. To extrapolate trial results to a lifetime horizon, the model was extended with one-month Markov cycles in which mortality risk is specific to the underlying disease. Data on the probabilities of IFI were obtained from Study Protocol PO1899. Drug costs were taken from average wholesale drug reports for 2009. Cost and health effects were discounted at 5% according to the Mexican guideline. The analysis was conducted from the Mexican healthcare perspective using 2008 unit cost prices. Results: Our model projects an accumulated cost to the Mexican healthcare system per patient receiving the Posaconazol regimen of $US 5,634 compared to $US 7,463 for the standard azole regimen. The accumulated discounted effect is 3.13 LY or 2.25 QALYs per patient receiving Posaconazol, compared to 2.96 LY or 2.13 QALYs per patient receiving standard azole. Posaconazol remained the dominant strategy across each scenario. Probabilistic sensitivity analysis tested numerous assumptions about the model cost and efficacy parameters and found that the results were robust to most changes. Conclusion: Posaconazole provides modest incremental benefits compared with standard azole therapy in the prophylaxis against IFIs among high-risk neutropenic patients. Routine Posaconazole use appears a cost saving when the likelihood of IFIs or the cost of treatment medications is high.

Original languageSpanish
JournalValue in Health
Volume14
Issue number5 SUPPL.
DOIs
StatePublished - Jul 2011

Fingerprint

Itraconazole
Fluconazole
Mexico
Cost-Benefit Analysis
Azoles
Costs and Cost Analysis
Quality-Adjusted Life Years
Therapeutics
Health Care Costs
Delivery of Health Care
Drug Costs
Invasive Fungal Infections
posaconazole
Guidelines
Mortality

Keywords

  • costo/efectividad
  • fluconazol
  • infecciones fngicas
  • itraconazol
  • posaconazol

ASJC Scopus subject areas

  • Health Policy
  • Public Health, Environmental and Occupational Health

Cite this

Costo Efectividad de Posaconazol versus Fluconazol/Itraconazol en el Tratamiento Profiláctico de las Infecciones Fúngicas Invasivas en México. / Rely, Kely; Alexandre, Pierre K.; Escudero, Guillermo Salinas.

In: Value in Health, Vol. 14, No. 5 SUPPL., 07.2011.

Research output: Contribution to journalArticle

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abstract = "Cost effectiveness of posaconazole versus fluconazole/itraconazole therapy in the prophylaxis against invasive fungal Infections among high-risk neutropenic patients in Mexico. Objective: To estimate the cost effectiveness and long-term combined effects of Posaconazole versus fluconazole/itraconazole (standard azole) therapy in the prophylaxis against invasive fungal Infections among high-risk neutropenic patients in Mexico. Methods: A previously validated Markov model was used to compare the projected lifetime costs and effects of two theoretical groups of patients, one receiving Posaconazole and the other receiving standard azole. The model estimates total costs, numbers of IFIs, and QALY per patient in each prophylaxis group. To extrapolate trial results to a lifetime horizon, the model was extended with one-month Markov cycles in which mortality risk is specific to the underlying disease. Data on the probabilities of IFI were obtained from Study Protocol PO1899. Drug costs were taken from average wholesale drug reports for 2009. Cost and health effects were discounted at 5{\%} according to the Mexican guideline. The analysis was conducted from the Mexican healthcare perspective using 2008 unit cost prices. Results: Our model projects an accumulated cost to the Mexican healthcare system per patient receiving the Posaconazol regimen of $US 5,634 compared to $US 7,463 for the standard azole regimen. The accumulated discounted effect is 3.13 LY or 2.25 QALYs per patient receiving Posaconazol, compared to 2.96 LY or 2.13 QALYs per patient receiving standard azole. Posaconazol remained the dominant strategy across each scenario. Probabilistic sensitivity analysis tested numerous assumptions about the model cost and efficacy parameters and found that the results were robust to most changes. Conclusion: Posaconazole provides modest incremental benefits compared with standard azole therapy in the prophylaxis against IFIs among high-risk neutropenic patients. Routine Posaconazole use appears a cost saving when the likelihood of IFIs or the cost of treatment medications is high.",
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