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American Journal of Health-System Pharmacy, Vol. 65, Issue 23, 2237-2243
Copyright © 2008. American Society of Health-System Pharmacists, Inc. All rights reserved. 1079-2082/04/0602-1242$06.00

Clinical Reports

Comparative cost-effectiveness of posaconazole versus fluconazole or itraconazole prophylaxis in patients with prolonged neutropenia

Curtis D. Collins, Jeffrey J. Ellis and Daniel R. Kaul

CURTIS D. COLLINS, PHARM.D., M.S., is Infectious Diseases Clinical Pharmacist, Department of Pharmacy Services, University of Michigan Health System, Ann Arbor. JEFFREY J. ELLIS, PHARM.D., M.S., is Pharmacy Clinical Operations Director, Trinity Health, Novi, MI. DANIEL R. KAUL, M.D., is Clinical Assistant Professor, Department of Medicine, Division of Infectious Disease, University of Michigan Health System.

Address correspondence to Dr. Collins at the Department of Pharmacy Services, University of Michigan Health System, UH B2D301/0008, 1500 East Medical Center Drive, Ann Arbor, MI 48109 (cdcollin{at}umich.edu).

Purpose. A cost-effectiveness analysis was performed to investigate the financial impact of using posaconazole versus fluconazole or itraconazole prophylaxis in patients with prolonged neutropenia. Methods. A decision-analytic model was developed from a hospital perspective based on the use of posaconazole versus fluconazole or itraconazole prophylaxis in patients with prolonged neutropenia (i.e., longer than 7–10 days). Data reported in a multicenter study, medication-cost information, and reports of costs to treat invasive fungal infections were used to accurately populate the model. Sensitivity analyses enhanced the robustness of the model through variation of all probabilities and costs. Results. In the base case, patients initiated on posaconazole displayed a 45% reduction in overall cost as compared with patients initiated on fluconazole or itraconazole ($3051 versus $5529, respectively). Sensitivity analyses determined that univariate changes in all model variables, including medication cost, duration of therapy, and cost of treating invasive fungal infections, did not impact overall results. A Monte Carlo simulation analysis found that use of posaconazole remains the best overall prophylactic strategy when taking into consideration the potential variance in all model assumptions. Posaconazole dominated the use of fluconazole or itraconazole because of previously demonstrated lower incidence of breakthrough fungal infections and lower overall treatment cost. Conclusion. The decision model indicated that use of posaconazole as prophylaxis in patients with prolonged neutropenia should result in lower overall treatment costs relative to the cost of fluconazole or itraconazole. Index terms: Antifungals; Costs; Drug comparisons; Fluconazole; Itraconazole; Neutropenia; Pharmacoeconomics; Posaconazole

 

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