El-Ghammaz Amro Mohamed Sedky, El-Zimaity Maha, Elafifi Amal Mostafa, Abdelwahed Essam, Moussa Mohamed Mahmoud, Aboelmagd Yasmin Ahmed, Kotob Mohamed Gamal, Fares Hebatullah Magdy
Clinical Hematology and Bone Marrow Transplantation Unit, Department of Internal Medicine, Faculty of Medicine, Ain Shams University, Cairo, Egypt.
Indian J Hematol Blood Transfus. 2020 Oct;36(4):680-689. doi: 10.1007/s12288-020-01259-y. Epub 2020 Feb 22.
Analyzing effectiveness and cost-effectiveness of voriconazole versus fluconazole prophylaxis in hematopoietic stem cell transplantation (HSCT).
The research included 70 patients; 34 undergoing allogeneic HSCT and 36 undergoing autologous stem cell transplantation (ASCT), alternated to receive either voriconazole or fluconazole prophylaxis for 180 days on a 1:1 basis. Patients were monitored for occurrence of invasive fungal infections (IFI), IFI-related death (IRD) and total death events. Cost-effectiveness of both agents in both groups was also assessed.
Antifungal prophylactic drug had no impact on incidence of IFI and IRD in both allogeneic HSCT and ASCT ( = .452 and = 1.000; = .457 and = .146 respectively). An insignificant difference occurred among patients receiving voriconazole or fluconazole regarding overall survival (OS) and fungal infection-free survival (FFS) in both groups ( = .705 and = .879; = .713 and = .681 respectively). Regarding cost-effectiveness, voriconazole dominated fluconazole regarding prevention of IFI and IRD but was less costly/less effective regarding prevention of total death events and gaining life years in the allogeneic HSCT setting. In the ASCT setting, voriconazole was not cost-effective regarding avoidance of IFI and IRD and was dominated by fluconazole regarding avoidance of total death events and gaining life years.
Voriconazole does not differ from fluconazole regarding its efficacy in prevention of IFI and IRD and does not improve OS and FFS in both allogeneic HSCT and ASCT settings. Voriconazole is cost-effective regarding protection from IFI and IRD in allogeneic HSCT but not cost-effective in ASCT.
分析伏立康唑与氟康唑在造血干细胞移植（HSCT）中预防用药的有效性和成本效益。
该研究纳入70例患者，其中34例行异基因HSCT，36例行自体干细胞移植（ASCT），患者按1:1比例交替接受伏立康唑或氟康唑预防用药180天。监测患者侵袭性真菌感染（IFI）、IFI相关死亡（IRD）及总死亡事件的发生情况。同时评估两组中两种药物的成本效益。
抗真菌预防用药对异基因HSCT和ASCT中IFI和IRD的发生率均无影响（分别为=0.452和=1.000；=0.457和=0.146）。两组中接受伏立康唑或氟康唑治疗的患者在总生存期（OS）和无真菌感染生存期（FFS）方面差异无统计学意义（分别为=0.705和=0.879；=0.713和=0.681）。在成本效益方面，在异基因HSCT中，伏立康唑在预防IFI和IRD方面优于氟康唑，但在预防总死亡事件和获得生存年数方面成本更高/效果更差。在ASCT中，伏立康唑在避免IFI和IRD方面不具有成本效益，在避免总死亡事件和获得生存年数方面被氟康唑所主导。
在预防IFI和IRD方面伏立康唑与氟康唑疗效无差异，在异基因HSCT和ASCT中均未改善OS和FFS。伏立康唑在异基因HSCT中预防IFI和IRD具有成本效益，但在ASCT中不具有成本效益。
