Pharmerit International, Bethesda, MD, USA.
BMC Pharmacol Toxicol. 2014 Sep 24;15:52. doi: 10.1186/2050-6511-15-52.
The current healthcare climate demands pharmacoeconomic evaluations for different treatment strategies incorporating drug acquisition costs, costs incurred for hospitalisation, drug administration and preparation, diagnostic and laboratory testing and drug-related adverse events (AEs). Here we evaluate the pharmacoeconomics of voriconazole versus liposomal amphotericin B as first-line therapies for invasive aspergillosis (IA) in patients with haematological malignancy and prolonged neutropenia or who were undergoing haematopoietic stem-cell transplantation in Germany or Spain.
A decision analytic model based on a decision tree was constructed to estimate the potential treatment costs of voriconazole versus liposomal amphotericin B. Each model pathway was defined by the probability of an event occurring and the costs of clinical outcomes. Outcome probabilities and cost inputs were derived from the published literature, clinical trials, expert panels and local database costs. In the base case, patients who failed to respond to first-line therapy were assumed to experience a single switch between comparator drugs or the other drug was added as second-line treatment. Base-case evaluation included only drug-management costs and additional hospitalisation costs due to severe AEs associated with first- and second-line therapies. Sensitivity analyses were conducted to assess the robustness of the results. Cost estimates were inflated to 2011 euros (€).
Based on clinical trial success rates of 52.8% (voriconazole) and 50.0% (liposomal amphotericin B), voriconazole had lower total treatment costs compared with liposomal amphotericin B in both Germany (€ 12,256 versus € 18,133; length of therapy [LOT] = 10-day intravenous [IV] + 5-day oral voriconazole and 15-day IV liposomal amphotericin B) and Spain (€ 8,032 versus € 10,516; LOT = 7-day IV + 8-day oral voriconazole and 15-day IV liposomal amphotericin B). Assuming the same efficacy (50.0%) in first-line therapy, voriconazole maintained a lower total treatment cost compared with liposomal amphotericin B. Cost savings were primarily due to the lower drug acquisition costs and shorter IV LOT associated with voriconazole. Sensitivity analyses showed that the results were sensitive to drug price, particularly the cost of liposomal amphotericin B.
Voriconazole is likely to be cost-saving compared with liposomal amphotericin B when used as a first-line treatment for IA in Germany and Spain.
当前的医疗保健环境要求对不同的治疗策略进行药物经济学评估，包括药物采购成本、住院费用、药物管理和准备、诊断和实验室检测以及与药物相关的不良事件（AE）。在此，我们评估了伏立康唑与两性霉素 B 脂质体作为德国和西班牙血液恶性肿瘤患者中性粒细胞减少持续时间延长或正在进行造血干细胞移植的侵袭性曲霉菌病（IA）一线治疗药物的药物经济学。
基于决策树构建了一个决策分析模型，以估算伏立康唑与两性霉素 B 脂质体的潜在治疗成本。每个模型路径都由事件发生的概率和临床结果的成本来定义。结果概率和成本投入来自已发表的文献、临床试验、专家小组和当地数据库成本。在基础情况下，假设一线治疗无反应的患者在两种比较药物之间进行单次转换，或者将另一种药物作为二线治疗药物添加。基础情况评估仅包括药物管理成本和与一线和二线治疗相关的严重 AE 导致的额外住院费用。进行了敏感性分析以评估结果的稳健性。成本估计值按 2011 年欧元（€）膨胀。
基于临床试验成功率为 52.8%（伏立康唑）和 50.0%（两性霉素 B 脂质体），与两性霉素 B 脂质体相比，伏立康唑在德国（€12256 对 €18133；治疗时间 [LOT]为 10 天静脉 [IV]加 5 天口服伏立康唑和 15 天 IV 两性霉素 B）和西班牙（€8032 对 €10516；LOT 为 7 天 IV 加 8 天口服伏立康唑和 15 天 IV 两性霉素 B）的总治疗成本均较低。假设一线治疗的疗效相同（50.0%），伏立康唑与两性霉素 B 脂质体相比，总治疗成本仍然较低。成本节约主要归因于伏立康唑较低的药物采购成本和较短的 IV LOT。敏感性分析表明，结果对药物价格敏感，尤其是两性霉素 B 的成本。
在德国和西班牙，与两性霉素 B 脂质体相比，伏立康唑作为侵袭性曲霉菌病的一线治疗药物可能具有成本效益。
