Rely Kely, Alexandre Pierre K, Escudero Guillermo Salinas
Economista de la salud, CEAHealthTech, México.
Value Health. 2011 Jul-Aug;14(5 Suppl 1):S39-42. doi: 10.1016/j.jval.2011.05.032.
Cost effectiveness of posaconazole versus fluconazole/itraconazole therapy in the prophylaxis against invasive fungal Infections among high-risk neutropenic patients in Mexico.
To estimate the cost effectiveness and long-term combined effects of Posaconazole versus fluconazole/itraconazole (standard azole) therapy in the prophylaxis against invasive fungal Infections among high-risk neutropenic patients in Mexico.
A previously validated Markov model was used to compare the projected lifetime costs and effects of two theoretical groups of patients, one receiving Posaconazole and the other receiving standard azole. The model estimates total costs, numbers of IFIs, and QALY per patient in each prophylaxis group. To extrapolate trial results to a lifetime horizon, the model was extended with one-month Markov cycles in which mortality risk is specific to the underlying disease. Data on the probabilities of IFI were obtained from Study Protocol PO1899. Drug costs were taken from average wholesale drug reports for 2009. Cost and health effects were discounted at 5% according to the Mexican guideline. The analysis was conducted from the Mexican healthcare perspective using 2008 unit cost prices.
Our model projects an accumulated cost to the Mexican healthcare system per patient receiving the Posaconazol regimen of $US 5,634 compared to $US 7,463 for the standard azole regimen. The accumulated discounted effect is 3.13 LY or 2.25 QALYs per patient receiving Posaconazol, compared to 2.96 LY or 2.13 QALYs per patient receiving standard azole. Posaconazol remained the dominant strategy across each scenario. Probabilistic sensitivity analysis tested numerous assumptions about the model cost and efficacy parameters and found that the results were robust to most changes.
Posaconazole provides modest incremental benefits compared with standard azole therapy in the prophylaxis against IFIs among high-risk neutropenic patients. Routine Posaconazole use appears a cost saving when the likelihood of IFIs or the cost of treatment medications is high.
泊沙康唑与氟康唑/伊曲康唑疗法在墨西哥高危中性粒细胞减少患者侵袭性真菌感染预防中的成本效益。
评估泊沙康唑与氟康唑/伊曲康唑（标准唑类）疗法在墨西哥高危中性粒细胞减少患者侵袭性真菌感染预防中的成本效益及长期综合效果。
使用先前验证的马尔可夫模型比较两组理论患者的预期终生成本和效果，一组接受泊沙康唑治疗，另一组接受标准唑类治疗。该模型估计每个预防组中每位患者的总成本、侵袭性真菌感染数量和质量调整生命年。为将试验结果外推至终生范围，模型以一个月的马尔可夫周期进行扩展，其中死亡风险因基础疾病而异。侵袭性真菌感染概率的数据来自研究方案PO1899。药品成本取自2009年的平均批发药品报告。根据墨西哥指南，成本和健康效果按5%进行贴现。分析从墨西哥医疗保健角度进行，采用2008年单位成本价格。
我们的模型预测，接受泊沙康唑治疗方案的每位患者给墨西哥医疗保健系统带来的累计成本为5634美元，而标准唑类治疗方案为7463美元。接受泊沙康唑治疗的每位患者的累计贴现效果为3.13生命年或2.25质量调整生命年，接受标准唑类治疗的每位患者为2.96生命年或2.13质量调整生命年。在每种情况下，泊沙康唑仍然是主导策略。概率敏感性分析测试了关于模型成本和疗效参数的众多假设，发现结果对大多数变化具有稳健性。
在高危中性粒细胞减少患者侵袭性真菌感染的预防中，与标准唑类疗法相比，泊沙康唑提供了适度的增量效益。当侵袭性真菌感染的可能性或治疗药物成本较高时，常规使用泊沙康唑似乎可节省成本。
