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REGINALD E. GREENE, M.D., is Radiologist, Massachusetts General Hospital, Boston, and Professor of Radiology, Harvard Medical School, Boston. JOSEPHINE MAUSKOPF, PHD . ., is Vice President for Health Economics, RTI International, Research Triangle Park, NC. CRAIG S. ROBERTS, PHARM.D ., M.P.A ., is Director of Health Economics, Pfizer Inc., New York, NY. TERESA ZYCZYNSKI, PHARMD . ., M.B.A ., M.P.H ., is Senior Director of Health Economics, General Electric Health Care, Princeton, NJ; at the time of this study she was Senior Director of Health Economics, Pfizer Inc. HARAN T. SCHLAMM, M.D., is Medical Director, Pfizer Global Research and Development, New York.

Address correspondence to Dr. Greene at Founders 202, Department of Radiology, Massachusetts General Hospital, Boston, MA 02114 (greene.reginald{at}mgh.harvard.edu).

Purpose. The comparative cost-effectiveness of voriconazole and amphotericin B in the treatment of invasive pulmonary aspergillosis (IPA) was examined. Methods. A decision-tree model was constructed comparing 12-week treatment outcomes in a subset of patients enrolled in a clinical trial comparing initial treatment of IPA with amphotericin B versus voriconazole. Patients included those with IPA who underwent a thoracic computed tomographic (CT) scan at baseline. Cost and survival were estimated for those with and without a halo sign at baseline. Incremental cost-effectiveness ratios comparing voriconazole with amphotericin B were calculated for both patient subgroups. Results. Patients with a halo sign had similar costs and better survival rates than those without the sign. Within the subgroup of patients with the sign, total costs were lower and survival rates higher for those treated with voriconazole than for those treated with amphotericin B. For patients without a halo sign, total costs and survival rates were higher for those treated with voriconazole versus amphotericin B. Conclusion. Among patients treated for IPA, those with a baseline CT halo sign, an early indicator of the condition, appeared to have better survival rates and lower health care costs compared with patients without the sign. In patients with the halo sign, survival rates were higher and costs were lower when voriconazole rather than amphotericin B was used as first-line treatment; survival was better with voriconazole than with amphotericin B when the halo sign was not present. Voriconazole was cost-effective compared with amphotericin B when the halo sign was present, but voriconazole’s cost-effectiveness when the sign was not present depended on the cost per life saved. Index terms: Amphotericin B; Antifungals; Aspergillosis; Drug comparisons; Economics; Methodology; Voriconazole