Pharmacy Department, Del Mar Hospital, Barcelona, Spain.
La Princesa Hospital, Calle de Diego de León, 62, 28006, Madrid, Spain.
Eur J Health Econ. 2018 May;19(4):627-636. doi: 10.1007/s10198-017-0907-5. Epub 2017 May 31.
The cost-effectiveness of posaconazole oral suspension versus fluconazole capsules for the prophylaxis of invasive fungal diseases (IFDs) in immunosuppressed allogeneic hematopoietic stem cell transplantation (HSCT) recipients has already been proven. Now, a new solid oral tablet formulation for posaconazole has been developed with improved bioavailability, allowing a reduced daily dosage that can be taken independently of food intake. However, the efficacy of this new formulation should be evaluated since it is associated with a higher cost than the posaconazole oral suspension.
To evaluate the cost-effectiveness of solid oral tablets of posaconazole versus fluconazole capsules for the prophylaxis of IFDs in allogeneic HSCT recipients with graft-versus-host disease (GVHD) in Spain.
A mathematical model comparing the efficacy and costs of posaconazole versus fluconazole was adapted to the Spanish National Healthcare System. Clinical data were obtained from the pivotal clinical trial of posaconazole oral suspension for allogeneic HSCT recipients, while pharmacological costs and use of resources were obtained from national sources. Deterministic and probabilistic sensitivity analyses (PSA), as well as two alternative scenarios, were run to evaluate the robustness of the results under varying input values.
Posaconazole tablets reduced the number of IFD events and enhanced overall survival, while maintaining a controlled budget. When compared to fluconazole, it was found to be a cost-effective alternative, with an incremental cost-effectiveness ratio of €13,193/life years gained. The PSA showed that posaconazole remained cost-effective in 74.6% of the cases, while alternatives scenarios yielded similar results as the base case.
Posaconazole tablets are a cost-effective alternative to fluconazole and may show better results than the oral suspension formulation.
泊沙康唑口服混悬液与氟康唑胶囊在预防免疫抑制的异基因造血干细胞移植（HSCT）受者侵袭性真菌感染（IFD）方面的成本效益已得到证实。现在，一种新的泊沙康唑固体口服片剂制剂已经开发出来，具有更好的生物利用度，允许减少每日剂量，并且可以不依赖于食物摄入。然而，由于其成本高于泊沙康唑口服混悬液，因此应该评估这种新制剂的疗效。
评估在西班牙患有移植物抗宿主病（GVHD）的异基因 HSCT 受者中，使用泊沙康唑固体口服片剂与氟康唑胶囊预防 IFD 的成本效益。
一种比较泊沙康唑与氟康唑疗效和成本的数学模型被适用于西班牙国家医疗保健系统。临床数据来自泊沙康唑口服混悬液治疗异基因 HSCT 受者的关键性临床试验，而药物经济学成本和资源使用则来自国家来源。进行了确定性和概率敏感性分析（PSA）以及两种替代方案，以评估在不同输入值下结果的稳健性。
泊沙康唑片剂减少了 IFD 事件的数量并提高了总体生存率，同时保持了预算的控制。与氟康唑相比，它被认为是一种具有成本效益的替代方案，增量成本效益比为每增加 1 个生命年需花费 13,193 欧元。PSA 表明，在 74.6%的情况下，泊沙康唑仍然具有成本效益，而替代方案的结果与基础方案相似。
泊沙康唑片剂是氟康唑的一种具有成本效益的替代方案，并且可能比口服混悬液制剂具有更好的效果。
