The cost-effectiveness of isavuconazole compared to voriconazole, the standard of care in the treatment of patients with invasive mould diseases, prior to differential pathogen diagnosis in Spain.
Antifungal Agents
/ economics
Aspergillosis
/ drug therapy
Clinical Laboratory Techniques
/ economics
Cost-Benefit Analysis
Diagnosis, Differential
Fungi
Hospitalists
/ economics
Humans
Mucormycosis
/ drug therapy
Nitriles
/ therapeutic use
Pyridines
/ therapeutic use
Spain
Standard of Care
Triazoles
/ therapeutic use
Voriconazole
/ therapeutic use
cost-effectiveness
decision tree
invasive aspergillosis
isavuconazole
mucormycosis
Journal
Mycoses
ISSN: 1439-0507
Titre abrégé: Mycoses
Pays: Germany
ID NLM: 8805008
Informations de publication
Date de publication:
Jan 2021
Jan 2021
Historique:
received:
28
07
2020
revised:
16
09
2020
accepted:
21
09
2020
pubmed:
30
9
2020
medline:
20
7
2021
entrez:
29
9
2020
Statut:
ppublish
Résumé
Invasive mould diseases are associated with high morbidity, mortality and economic impact. Its treatment is often started prior to differential pathogen diagnosis. Isavuconazole is approved for treatment of invasive aspergillosis (IA) and invasive mucormycosis (IM) when amphotericin-B is not indicated. To estimate the cost-effectiveness of isavuconazole vs voriconazole for the treatment of adult patients with possible IA prior to differential pathogen diagnosis, in Spain. A decision tree analysis was performed using the Spanish Healthcare System perspective. Among all patients with possible IA, it was considered that 7.81% actually had IM. Costs for laboratory analysis, management of adverse events, hospitalisation and drugs per patient, deaths and long-term effects in life years (LYs) and quality-adjusted LYs (QALYs) were considered. Efficacy data were obtained from clinical trials and utilities from the literature. Deterministic and probabilistic sensitivity analyses (PSA) were conducted. In patients with possible IA and when compared to voricanozole, isavuconazole showed an incremental cost of 4758.53€, besides an incremental effectiveness of +0.49 LYs and +0.41 QALYs per patient. The Incremental Cost Effectiveness Ratio was 9622.52€ per LY gained and 11,734.79€ per QALY gained. The higher cost of isavuconazole was due to drug acquisition. Main parameters influencing results were mortality, treatment duration and hospitalisation days. The PSA results showed that isavuconazole has a probability of being cost-effective of 67.34%, being dominant in 24.00% of cases. Isavuconazole is a cost-effective treatment compared to voriconazole for patients with possible IA for a willingness to pay threshold of 25,000€ per additional QALY.
Sections du résumé
BACKGROUND
BACKGROUND
Invasive mould diseases are associated with high morbidity, mortality and economic impact. Its treatment is often started prior to differential pathogen diagnosis. Isavuconazole is approved for treatment of invasive aspergillosis (IA) and invasive mucormycosis (IM) when amphotericin-B is not indicated.
OBJECTIVES
OBJECTIVE
To estimate the cost-effectiveness of isavuconazole vs voriconazole for the treatment of adult patients with possible IA prior to differential pathogen diagnosis, in Spain.
METHODS
METHODS
A decision tree analysis was performed using the Spanish Healthcare System perspective. Among all patients with possible IA, it was considered that 7.81% actually had IM. Costs for laboratory analysis, management of adverse events, hospitalisation and drugs per patient, deaths and long-term effects in life years (LYs) and quality-adjusted LYs (QALYs) were considered. Efficacy data were obtained from clinical trials and utilities from the literature. Deterministic and probabilistic sensitivity analyses (PSA) were conducted.
RESULTS
RESULTS
In patients with possible IA and when compared to voricanozole, isavuconazole showed an incremental cost of 4758.53€, besides an incremental effectiveness of +0.49 LYs and +0.41 QALYs per patient. The Incremental Cost Effectiveness Ratio was 9622.52€ per LY gained and 11,734.79€ per QALY gained. The higher cost of isavuconazole was due to drug acquisition. Main parameters influencing results were mortality, treatment duration and hospitalisation days. The PSA results showed that isavuconazole has a probability of being cost-effective of 67.34%, being dominant in 24.00% of cases.
CONCLUSIONS
CONCLUSIONS
Isavuconazole is a cost-effective treatment compared to voriconazole for patients with possible IA for a willingness to pay threshold of 25,000€ per additional QALY.
Identifiants
pubmed: 32989796
doi: 10.1111/myc.13189
pmc: PMC7894146
doi:
Substances chimiques
Antifungal Agents
0
Nitriles
0
Pyridines
0
Triazoles
0
isavuconazole
60UTO373KE
Voriconazole
JFU09I87TR
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
66-77Subventions
Organisme : Pfizer
Informations de copyright
© 2020 Pfizer SLU. Mycoses published by Wiley-VCH GmbH.
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