Covance Market Access, London, UK.
Basilea Pharmaceutica International Ltd, Basel, Switzerland.
BMC Infect Dis. 2019 Feb 11;19(1):134. doi: 10.1186/s12879-019-3683-2.
Voriconazole is well established as standard treatment for invasive aspergillosis (IA). In 2017, isavuconazole, a new antifungal from the azole class, with a broader pathogen spectrum, was introduced in Sweden. A model has therefore been developed to compare the cost-effectiveness of isavuconazole and voriconazole in the treatment of possible IA in adults in Sweden.
The cost-effectiveness of isavuconazole versus voriconazole was evaluated using a decision-tree model. Patients with possible IA entered the model, with 6% assumed to actually have mucormycosis. It was also assumed that pathogen information would become available during the course of treatment for only 50% of patients, with differential diagnosis unavailable for the remainder. Patients who were considered unresponsive to first-line treatment were switched to second-line treatment with liposomal amphotericin-B. Data and clinical definitions included in the model were taken from the published randomised clinical trial comparing isavuconazole with voriconazole for the treatment of IA and other filamentous fungi (SECURE) and the single-arm, open-label trial and case-control analysis of isavuconazole for the treatment of mucormycosis (VITAL). A probabilistic sensitivity analysis was used to estimate the combined parameter uncertainty, and a deterministic sensitivity analysis and a scenario analysis were performed to test the robustness of the model assumptions. The model followed a Swedish healthcare payer perspective, therefore only considering direct medical costs.
The base case analysis showed that isavuconazole resulted in an incremental cost-effectiveness ratio (ICER) of 174,890 Swedish krona (SEK) per additional quality adjusted life-year (QALY) gained. This was mainly due to the efficacy of isavuconazole against IA and mucormycosis, as opposed to voriconazole, which is only effective against IA. Sensitivity and scenario analyses of the data showed that the average ICER consistently fell below the willingness to pay (WTP) threshold of 1,000,000 SEK. The probability of isavuconazole being cost-effective at a WTP of 170,000 SEK per QALY gained was 50% and at a WTP of 500,000 SEK per QALY gained was 100%.
This model suggests that the treatment of possible IA with isavuconazole is cost-effective compared with treatment with voriconazole from a Swedish healthcare payer perspective.
伏立康唑已被确立为侵袭性曲霉病（IA）的标准治疗方法。2017 年，新型唑类抗真菌药物伊曲康唑在瑞典上市，其病原体谱更广。因此，建立了一个模型来比较伊曲康唑和伏立康唑治疗瑞典成年人疑似 IA 的成本效益。
使用决策树模型评估伊曲康唑与伏立康唑的成本效益。疑似 IA 的患者进入模型，假定有 6%的患者实际上患有毛霉菌病。还假设只有 50%的患者在治疗过程中可以获得病原体信息，其余患者无法进行鉴别诊断。对一线治疗无反应的患者改用两性霉素 B 脂质体进行二线治疗。模型中包含的数据和临床定义取自比较伊曲康唑与伏立康唑治疗 IA 和其他丝状真菌的随机临床试验（SECURE），以及伊曲康唑治疗毛霉菌病的单臂、开放标签试验和病例对照分析（VITAL）。使用概率敏感性分析估计综合参数不确定性，并进行确定性敏感性分析和情景分析，以测试模型假设的稳健性。该模型遵循瑞典医疗保健支付者的观点，因此仅考虑直接医疗成本。
基础案例分析显示，与伏立康唑相比，伊曲康唑的增量成本效益比（ICER）为每增加一个质量调整生命年（QALY）增加 174,890 瑞典克朗（SEK）。这主要是由于伊曲康唑对 IA 和毛霉菌病的疗效，而伏立康唑仅对 IA 有效。对数据的敏感性和情景分析表明，平均 ICER 始终低于 100 万瑞典克朗的意愿支付（WTP）阈值。在 WTP 为 170,000 瑞典克朗/QALY 时，伊曲康唑具有成本效益的概率为 50%，在 WTP 为 500,000 瑞典克朗/QALY 时，伊曲康唑具有成本效益的概率为 100%。
从瑞典医疗保健支付者的角度来看，使用伊曲康唑治疗疑似 IA 比使用伏立康唑治疗具有成本效益。
