Princess Margaret Hospital, Toronto, ON, Canada.
Support Care Cancer. 2011 Nov;19(11):1807-13. doi: 10.1007/s00520-010-1022-7. Epub 2010 Oct 23.
Invasive fungal infections (IFI) remain a clinical concern in hematological patients with prolonged neutropenia because they are a major cause of morbidity and mortality. In a recent randomized trial, prophylaxis with posaconazole was associated with fewer IFI and related deaths relative to a fluconazole or itraconazole (Flu/Itra) control group (p < 0.001). In the current study, a cost effectiveness analysis was conducted to estimate the economic value of posaconazole as an alternative to Flu/Itra when used to prevent IFI in this patient population.
A decision analysis model was developed using clinical and economic data from randomized comparative trials, the economic literature, and from expert opinion. The data were then used to estimate the incremental cost per life year saved with oral posaconazole prophylaxis relative to Flu/Itra from the Canadian provincial health care system perspective. The base case results were then tested with a sensitivity analysis which evaluated extremes in the incidence of IFI as well as variations in their cost of management.
Prophylaxis with posaconazole provides increased efficacy and an overall cost savings of approximately $Can4,259 per patient. Despite variations in the base case parameters, the sensitivity analysis suggested stability in the primary findings. Posaconazole was associated with an overall cost savings (range = $Can1,765 to $Can4,505) in all of the scenarios evaluated. Optimal cost effectiveness was obtained because the drug was able to avoid the more resource intensive Aspergillus infections.
Prophylaxis with posaconazole in cancer patients with prolonged neutropenia is not only cost effective but also cost saving. The economic benefits were due to the drug's ability to reduce the incidence of high cost fungal infections, particularly Aspergillus species.
在中性粒细胞减少症持续时间较长的血液病患者中，侵袭性真菌感染（IFI）仍然是一个临床关注点，因为它们是发病率和死亡率的主要原因。在最近的一项随机试验中，与氟康唑或伊曲康唑（氟康唑/伊曲康唑）对照组相比，预防性使用泊沙康唑可降低IFI 和相关死亡的发生率（p<0.001）。在本研究中，进行了一项成本效益分析，以估计泊沙康唑作为替代氟康唑/伊曲康唑用于预防该患者人群IFI 的经济价值。
使用来自随机对照试验、经济文献和专家意见的临床和经济数据，开发了一种决策分析模型。然后，使用这些数据从加拿大省级卫生保健系统的角度估计使用口服泊沙康唑预防相对于氟康唑/伊曲康唑的每例生命年增量成本。然后使用敏感性分析测试基本案例结果，该分析评估了 IFI 发生率的极值以及管理成本的变化。
泊沙康唑预防可提高疗效，并为每位患者节省约 4259 加元的总体成本。尽管基本案例参数存在差异，但敏感性分析表明主要发现稳定。在评估的所有情况下，泊沙康唑均与总体成本节省相关（范围为 1765 加元至 4505 加元）。由于该药物能够避免更具资源密集性的曲霉属感染，因此实现了最佳的成本效益。
在中性粒细胞减少症持续时间较长的癌症患者中，预防性使用泊沙康唑不仅具有成本效益，而且还具有成本节约。经济效益是由于药物能够降低高成本真菌感染（尤其是曲霉菌属）的发生率。
