Health Economics, RTI Health Solutions, Research Triangle Park, NC 12194, USA.
Am J Health Syst Pharm. 2013 Sep 1;70(17):1518-27. doi: 10.2146/ajhp120599.
The cost-effectiveness of voriconazole versus fluconazole prophylaxis against fungal infections in hematopoietic cell transplant (HCT) recipients is investigated.
A decision-analytic model was developed to estimate the drug costs associated with planned or supplemental prophylaxis and empirical therapy and the costs of treating suspected or documented invasive fungal infections (IFIs) in HCT recipients. Published clinical trial data on 599 patients who received 100-180 days of prophylactic therapy with voriconazole or fluconazole were used to model specified IFI-prevention and mortality outcomes; 6-month, 12-month, and lifetime incremental cost-effectiveness ratios (ICERs) were estimated, with a bootstrap analysis performed to reffect the uncertainty of the clinical trial data.
Estimated mean total prophylaxis and IFI-related costs associated with voriconazole versus fluconazole prophylaxis over 12 months were higher in the entire study population and among patients receiving HCT for diagnoses other than acute myeloid leukemia (AML) but were not significantly different for patients with AML. The cost per IFI avoided ($66,919) and the cost per life-year gained ($5,453) were lower among patients with AML who received voriconazole relative to the full study population. ICERs were more favorable for voriconazole over a 6-month time frame and when modeling was conducted using generic price data. Assuming a threshold value of $50,000 for one year of life gained, the calculated probability of voriconazole being cost-effective was 33% for the full study population and 85% for the AML subgroup.
The decision model indicated that voriconazole prophylaxis was cost-effective for patients undergoing allogeneic HCT for AML.
研究伏立康唑与氟康唑预防造血细胞移植（HCT）受者真菌感染的成本效益。
开发了一个决策分析模型，以估计与计划或补充预防和经验性治疗相关的药物成本，以及治疗 HCT 受者疑似或确诊侵袭性真菌感染（IFI）的成本。使用发表的临床试验数据对 599 例接受伏立康唑或氟康唑 100-180 天预防性治疗的患者进行建模，以模拟特定的 IFI 预防和死亡率结果；使用.bootstrap 分析来估计 6 个月、12 个月和终生增量成本效益比（ICER），以反映临床试验数据的不确定性。
在整个研究人群和接受除急性髓细胞白血病（AML）以外的诊断的 HCT 患者中，与氟康唑相比，使用伏立康唑进行 12 个月的总预防和 IFI 相关成本估计更高，但在 AML 患者中没有显著差异。与整个研究人群相比，接受伏立康唑治疗的 AML 患者避免 IFI 的成本（$66,919）和获得的生命年成本（$5,453）更低。在 6 个月的时间框架内，以及在使用仿制药价格数据进行建模时，伏立康唑的 ICER 更有利。假设获得一年生命的阈值为 50,000 美元，那么在整个研究人群中，伏立康唑具有成本效益的概率为 33%，在 AML 亚组中为 85%。
决策模型表明，伏立康唑预防对接受异基因 HCT 治疗 AML 的患者具有成本效益。
