Department of Health Economics, National School of Public Health, Athens, Greece.
J Med Econ. 2013;16(5):678-84. doi: 10.3111/13696998.2013.781028. Epub 2013 Mar 13.
Invasive fungal infections (IFIs) present a major issue in clinical practice, due to their high morbidity and mortality rates. In a pivotal multi-centre, randomized clinical trial, posaconazole prophylaxis prevented IFIs more effectively than did either fluconazole or itraconazole, and improved overall survival.
The aim of this study was to perform an economic evaluation of the aforementioned therapeutic strategies for IFI prophylaxis in neutropenic patients, in the Greek healthcare setting.
A decision analytic model was developed, which described the course of neutropenic patients under posaconazole or standard azole (fluconazole or itraconazole) treatment. Effectiveness data for each treatment regimen were derived from published results of a pivotal, multi-centre, randomized clinical trial. Cost and healthcare resources utilization data depict Greek clinical practice and are derived from official Greek sources, from a third party payer perspective.
Prophylaxis with posaconazole resulted in fewer IFIs (0.05 vs 0.11 per patient) compared to treatment with fluconazole or itraconazole, during the first 100 days from initiation of prophylaxis treatment. The cost per avoided IFI with posaconazole was €6455, while the incremental cost per life year gained (LYG) was estimated at €24,196. Extensive sensitivity analyses corroborated the base-case results. Possible limitations of the study are the exclusion of indirect and outpatient costs from the analysis and the inherent uncertainty with regards to the transferability of the clinical efficacy results of the clinical trial to the Greek healthcare setting.
The utilization of posaconazole for prophylaxis of IFIs neutropenic patients is a therapeutic strategy that provides superior clinical efficacy, while being cost-effective compared to alternative therapies.
侵袭性真菌感染（IFI）在临床实践中是一个主要问题，因为它们具有很高的发病率和死亡率。在一项关键的多中心、随机临床试验中，泊沙康唑预防比氟康唑或伊曲康唑更有效地预防 IFI，并改善了总体生存率。
本研究旨在对中性粒细胞减少症患者IFI 预防的上述治疗策略在希腊医疗保健环境中进行经济评估。
开发了一种决策分析模型，描述了泊沙康唑或标准唑（氟康唑或伊曲康唑）治疗下中性粒细胞减少症患者的病程。每种治疗方案的有效性数据均来自一项关键的多中心随机临床试验的已发表结果。成本和医疗资源利用数据描绘了希腊的临床实践，并源自官方希腊来源，从第三方支付者的角度出发。
与氟康唑或伊曲康唑相比，泊沙康唑预防在预防治疗开始后的前 100 天内导致的 IFI 更少（每位患者 0.05 与 0.11 次）。使用泊沙康唑预防每例避免 IFI 的成本为 6455 欧元，而每获得一个生命年（LYG）的增量成本估计为 24196 欧元。广泛的敏感性分析证实了基础案例的结果。研究的可能局限性是排除了分析中的间接和门诊成本，以及临床试验的临床疗效结果在希腊医疗保健环境中的可转移性的固有不确定性。
与替代疗法相比，泊沙康唑用于预防中性粒细胞减少症患者的 IFI 是一种提供卓越临床疗效且具有成本效益的治疗策略。
