Merck & Co., Inc. , Lebanon, NJ , USA.
J Med Econ. 2015 May;18(5):341-8. doi: 10.3111/13696998.2014.1000460. Epub 2015 Mar 2.
Posaconazole has shown superior clinical efficacy in the prevention of invasive fungal disease (IFD) among neutropenic patients as well as cost-effectiveness in the US healthcare setting vs fluconazole or itraconazole (FLU/ITRA) based on oral suspension formulations of each therapy. This study aims to provide an update on the cost-effectiveness of posaconazole in the current US healthcare setting to reflect bioequivalent tablet formulations of posaconazole and fluconazole, as well as changes in healthcare and drug costs.
An existing model was used to assess the cost-effectiveness of posaconazole vs FLU/ITRA in the prevention of IFD among patients with acute myelogenous leukemia (AML) or myelodysplastic syndrome (MDS) and chemotherapy-induced neutropenia. Drug efficacy, mortality related to IFD, and death from other causes were estimated for tablet formulations using data from a randomized clinical trial of oral suspensions based on bioequivalence. IFD treatment costs were updated using the average inflation rate over 8 years (2006-2014) and drug costs were based on 2014 Analysource data.
Trial data show a lower IFD probability over 100 days of follow-up with posaconazole compared to standard azole therapy (0.05 vs 0.11). The treatment duration on posaconazole is 29 days compared to 24 days for FLU and 29 days for ITRA. The average cost of prophylaxis is higher in the posaconazole group compared to FLU/ITRA ($4673 vs $353); however, the costs associated with treating the IFD are lower in the posaconazole group compared to FLU/ITRA ($2205 vs $5303). The incremental cost effectiveness ratio of IFD avoided for posaconazole is $18,898 vs FLU/ITRA.
In the current healthcare cost environment where both drug costs and overall IFD treatment costs have increased since 2007, posaconazole tablets are a cost-effective alternative to fluconazole or itraconazole in the prevention of IFD among neutropenic patients with AML and MDS in the US.
泊沙康唑在预防中性粒细胞减少症患者侵袭性真菌感染（IFI）方面的临床疗效优于氟康唑或伊曲康唑（FLU/ITRA），且基于每种药物的口服混悬剂配方，具有成本效益。本研究旨在根据泊沙康唑和氟康唑的生物等效片剂配方以及医疗保健和药物成本的变化，提供当前美国医疗保健环境下泊沙康唑成本效益的最新信息。
使用现有模型评估泊沙康唑与 FLU/ITRA 在预防急性髓细胞白血病（AML）或骨髓增生异常综合征（MDS）和化疗引起的中性粒细胞减少症患者IFI 方面的成本效益。使用口服混悬剂生物等效性随机临床试验的片剂制剂数据，估算了生物等效性片剂制剂的药物疗效、IFI 相关死亡率和其他原因导致的死亡率。使用 8 年（2006-2014 年）的平均通胀率更新了 IFD 治疗成本，并根据 2014 年 Analysource 数据估算了药物成本。
试验数据显示，与标准唑类治疗相比，泊沙康唑在 100 天随访期间的 IFD 概率更低（0.05 对 0.11）。泊沙康唑的治疗持续时间为 29 天，而氟康唑为 24 天，伊曲康唑为 29 天。与 FLU/ITRA 相比，泊沙康唑组预防的平均成本更高（4673 美元对 353 美元）；然而，与 FLU/ITRA 相比，泊沙康唑组治疗 IFD 的成本更低（2205 美元对 5303 美元）。IFD 避免的增量成本效益比为泊沙康唑 18898 美元，FLU/ITRA。
在当前的医疗保健成本环境下，自 2007 年以来，药物成本和整体 IFD 治疗成本都有所增加，泊沙康唑片剂是中性粒细胞减少症 AML 和 MDS 患者预防 IFD 的一种具有成本效益的氟康唑或伊曲康唑替代药物。
