Clinicoecon Outcomes Res. 2016 Dec 30;9:39-47. doi: 10.2147/CEOR.S122177. eCollection 2017.
Cost-effectiveness analysis of combination antifungal therapy with voriconazole and anidulafungin versus voriconazole monotherapy for primary treatment of invasive aspergillosis in Spain.
ClinicoEconomics and outcomes research : CEOR
Santiago Grau, Jose Ramon Azanza, Isabel Ruiz, Carlos Vallejo, Josep Mensa, Johan Maertens, Werner J Heinz, Jon Andoni Barrueta, Carmen Peral, Francisco Jesús Mesa, Miguel Barrado, Claudie Charbonneau, Darío Rubio-Rodríguez, Carlos Rubio-Terrés
Affiliations
Affiliations
- Pharmacy Department, Hospital del Mar, Universitat Autònoma de Barcelona, Barcelona.
- Clinical Pharmacology Department, Clínica Universidad de Navarra, Pamplona.
- Infectious Diseases Department, Hospital Universitari Vall d'Hebron, Barcelona.
- Hematology Department, Hospital Universitario Donostia, San Sebastián.
- Infectious Diseases Department, Hospital Clínic de Barcelona, Barcelona, Spain.
- Hematology Department, University Hospital Gasthuisberg, Leuven, Belgium.
- Hematology/Oncology Department, Medizinische Klinik und Poliklinik II, Universitätsklinikum, Würzburg, Germany.
- Medical Department.
- Economics and Outcomes Research Department, Pfizer S.L.U, Alcobendas.
- Clinical Trials Department, Trial Form Support, Madrid, Spain.
- Pharmacoeconomics Department, Pfizer International Operations, Paris, France.
- Pharmacoeconomics Department, Health Value, Madrid, Spain.
PMID: 28115858
PMCID: PMC5221484 DOI: 10.2147/CEOR.S122177
Abstract
OBJECTIVE: According to a recent randomized, double-blind clinical trial comparing the combination of voriconazole and anidulafungin (VOR+ANI) with VOR monotherapy for invasive aspergillosis (IA) in patients with hematologic disease or with hematopoietic stem cell transplant, mortality was lower after 6 weeks with VOR+ANI than with VOR monotherapy in a post hoc analysis of patients with galactomannan-based IA. The objective of this study was to compare the cost-effectiveness of VOR+ANI with VOR, from the perspective of hospitals in the Spanish National Health System.
METHODS: An economic model with deterministic and probabilistic analyses was used to determine costs per life-year gained (LYG) for VOR+ANI versus VOR in patients with galactomannan-based IA. Mortality, adverse event rates, and life expectancy were obtained from clinical trial data. The costs (in 2015 euros [€]) of the drugs and the adverse event-related costs were obtained from Spanish sources. A Tornado plot and a Monte Carlo simulation (1,000 iterations) were used to assess uncertainty of all model variables.
RESULTS: According to the deterministic analysis, for each patient treated with VOR+ANI compared with VOR monotherapy, there would be a total of 0.348 LYG (2.529 vs 2.181 years, respectively) at an incremental cost of €5,493 (€17,902 vs €12,409, respectively). Consequently, the additional cost per LYG with VOR+ANI compared with VOR would be €15,785. Deterministic sensitivity analyses confirmed the robustness of these findings. In the probabilistic analysis, the cost per LYG with VOR+ANI was €15,774 (95% confidence interval: €15,763-16,692). The probability of VOR+ANI being cost-effective compared with VOR was estimated at 82.5% and 91.9%, based on local cost-effectiveness thresholds of €30,000 and €45,000, respectively.
CONCLUSION: According to the present economic study, combination therapy with VOR+ANI is cost-effective as primary therapy of IA in galactomannan-positive patients in Spain who have hematologic disease or hematopoietic stem cell transplant, compared with VOR monotherapy.
Keywords: anidulafungin; cost-effectiveness; galactomannan; invasive aspergillosis; voriconazole
Conflict of interest statement
JAB, CP, and FJM are employees of Pfizer S.L.U. (Spain). WJH has received research grants from MSD Sharp & Dohme/Merck and Pfizer; served on speaker bureaus for Alexion, Astellas, Basilea, Bristol-Mye
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