Economic evaluation of azoles as primary prophylaxis for the prevention of invasive fungal infections in Spanish patients undergoing allogeneic haematopoietic stem cell transplant.
Identifieur interne : 003A42 ( Ncbi/Merge ); précédent : 003A41; suivant : 003A43Economic evaluation of azoles as primary prophylaxis for the prevention of invasive fungal infections in Spanish patients undergoing allogeneic haematopoietic stem cell transplant.
Auteurs : Carlos Solano [Espagne] ; Monica Slavin [Australie] ; Alissa J. Shaul [États-Unis] ; David I. Marks [Royaume-Uni] ; Catherine Cordonnier [France] ; Oliver A. Cornely [Allemagne] ; Antonio Pagliuca [Royaume-Uni] ; Lael Cragin [États-Unis] ; Isidro Jarque [Espagne] ; Carolina Garcia-Vidal [Espagne] ; Sonja Sorensen [États-Unis] ; David J. Vanness [États-Unis] ; Claudie Charbonneau [France] ; Jon Andoni Barrueta [Espagne] ; Carmen Peral [Espagne] ; Marina De Salas-Cansado [Espagne] ; Eric J. Bow [Canada]Source :
- Mycoses [ 1439-0507 ] ; 2017.
Descripteurs français
- KwdFr :
- Adulte, Analyse coût-bénéfice, Antifongiques (usage thérapeutique), Antifongiques (économie), Espagne, Fluconazole (usage thérapeutique), Fluconazole (économie), Humains, Infections fongiques invasives (), Infections fongiques invasives (ethnologie), Infections fongiques invasives (microbiologie), Infections fongiques invasives (économie), Itraconazole (usage thérapeutique), Itraconazole (économie), Techniques d'aide à la décision, Transplantation de cellules souches hématopoïétiques, Triazoles (usage thérapeutique), Triazoles (économie), Voriconazole (usage thérapeutique).
- MESH :
- ethnologie : Infections fongiques invasives.
- microbiologie : Infections fongiques invasives.
- usage thérapeutique : Antifongiques, Fluconazole, Itraconazole, Triazoles, Voriconazole.
- économie : Antifongiques, Fluconazole, Infections fongiques invasives, Itraconazole, Triazoles.
- Adulte, Analyse coût-bénéfice, Espagne, Humains, Infections fongiques invasives, Techniques d'aide à la décision, Transplantation de cellules souches hématopoïétiques.
English descriptors
- KwdEn :
- Adult, Antifungal Agents (economics), Antifungal Agents (therapeutic use), Cost-Benefit Analysis, Decision Support Techniques, Fluconazole (economics), Fluconazole (therapeutic use), Hematopoietic Stem Cell Transplantation, Humans, Invasive Fungal Infections (economics), Invasive Fungal Infections (ethnology), Invasive Fungal Infections (microbiology), Invasive Fungal Infections (prevention & control), Itraconazole (economics), Itraconazole (therapeutic use), Spain, Triazoles (economics), Triazoles (therapeutic use), Voriconazole (therapeutic use).
- MESH :
- chemical , economics : Antifungal Agents, Fluconazole, Itraconazole, Triazoles.
- chemical , therapeutic use : Antifungal Agents, Fluconazole, Itraconazole, Triazoles, Voriconazole.
- economics : Invasive Fungal Infections.
- ethnology : Invasive Fungal Infections.
- microbiology : Invasive Fungal Infections.
- prevention & control : Invasive Fungal Infections.
- Adult, Cost-Benefit Analysis, Decision Support Techniques, Hematopoietic Stem Cell Transplantation, Humans, Spain.
Abstract
Patients undergoing allogeneic haematopoietic stem cell transplantation (alloHSCT) are at risk of developing invasive fungal infections (IFIs). Even with introduction of oral triazole antifungal agents (fluconazole, itraconazole, posaconazole and voriconazole) IFI-associated morbidity and mortality rates and economic burden remain high. Despite their proven efficacy, it is currently unknown which is the most cost-effective antifungal prophylaxis (AFP) agent. To determine the costs and outcomes associated with AFP, a decision-analytic model was used to simulate treatment in a hypothetical cohort of 1000 patients undergoing alloHSCT from the perspective of the Spanish National Health System. Generic itraconazole was the least costly AFP (€162) relative to fluconazole (€500), posaconazole oral suspension (€8628) or voriconazole (€6850). Compared with posaconazole, voriconazole was associated with the lowest number of breakthrough IFIs (36 vs 60); thus, the model predicted fewer deaths from breakthrough IFI for voriconazole (24) than posaconazole (33), and the lowest predicted costs associated with other licensed antifungal treatment and IFI treatment in a cohort of 1000. Voriconazole resulted in cost savings of €4707 per patient compared with posaconazole. Itraconazole demonstrated a high probability of being cost-effective. As primary AFP in alloHSCT patients 180 days posttransplant, voriconazole was more likely to be cost-effective than posaconazole regarding cost per additional IFI and additional death avoided.
DOI: 10.1111/myc.12552
PubMed: 27562016
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pubmed:27562016Le document en format XML
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<author><name sortKey="Shaul, Alissa J" sort="Shaul, Alissa J" uniqKey="Shaul A" first="Alissa J" last="Shaul">Alissa J. Shaul</name>
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<author><name sortKey="Cordonnier, Catherine" sort="Cordonnier, Catherine" uniqKey="Cordonnier C" first="Catherine" last="Cordonnier">Catherine Cordonnier</name>
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<author><name sortKey="Cornely, Oliver A" sort="Cornely, Oliver A" uniqKey="Cornely O" first="Oliver A" last="Cornely">Oliver A. Cornely</name>
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<author><name sortKey="Cragin, Lael" sort="Cragin, Lael" uniqKey="Cragin L" first="Lael" last="Cragin">Lael Cragin</name>
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<author><name sortKey="Vanness, David J" sort="Vanness, David J" uniqKey="Vanness D" first="David J" last="Vanness">David J. Vanness</name>
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<author><name sortKey="Barrueta, Jon Andoni" sort="Barrueta, Jon Andoni" uniqKey="Barrueta J" first="Jon Andoni" last="Barrueta">Jon Andoni Barrueta</name>
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<author><name sortKey="Peral, Carmen" sort="Peral, Carmen" uniqKey="Peral C" first="Carmen" last="Peral">Carmen Peral</name>
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<author><name sortKey="De Salas Cansado, Marina" sort="De Salas Cansado, Marina" uniqKey="De Salas Cansado M" first="Marina" last="De Salas-Cansado">Marina De Salas-Cansado</name>
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<country xml:lang="fr">Espagne</country>
<wicri:regionArea>Pfizer Inc, Madrid</wicri:regionArea>
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<author><name sortKey="Bow, Eric J" sort="Bow, Eric J" uniqKey="Bow E" first="Eric J" last="Bow">Eric J. Bow</name>
<affiliation wicri:level="4"><nlm:affiliation>CancerCare Manitoba, University of Manitoba, Winnipeg, MB, Canada.</nlm:affiliation>
<country xml:lang="fr">Canada</country>
<wicri:regionArea>CancerCare Manitoba, University of Manitoba, Winnipeg, MB</wicri:regionArea>
<orgName type="university">Université du Manitoba</orgName>
<placeName><settlement type="city">Winnipeg</settlement>
<region type="state">Manitoba</region>
</placeName>
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<series><title level="j">Mycoses</title>
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<imprint><date when="2017" type="published">2017</date>
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<term>Antifungal Agents (economics)</term>
<term>Antifungal Agents (therapeutic use)</term>
<term>Cost-Benefit Analysis</term>
<term>Decision Support Techniques</term>
<term>Fluconazole (economics)</term>
<term>Fluconazole (therapeutic use)</term>
<term>Hematopoietic Stem Cell Transplantation</term>
<term>Humans</term>
<term>Invasive Fungal Infections (economics)</term>
<term>Invasive Fungal Infections (ethnology)</term>
<term>Invasive Fungal Infections (microbiology)</term>
<term>Invasive Fungal Infections (prevention & control)</term>
<term>Itraconazole (economics)</term>
<term>Itraconazole (therapeutic use)</term>
<term>Spain</term>
<term>Triazoles (economics)</term>
<term>Triazoles (therapeutic use)</term>
<term>Voriconazole (therapeutic use)</term>
</keywords>
<keywords scheme="KwdFr" xml:lang="fr"><term>Adulte</term>
<term>Analyse coût-bénéfice</term>
<term>Antifongiques (usage thérapeutique)</term>
<term>Antifongiques (économie)</term>
<term>Espagne</term>
<term>Fluconazole (usage thérapeutique)</term>
<term>Fluconazole (économie)</term>
<term>Humains</term>
<term>Infections fongiques invasives ()</term>
<term>Infections fongiques invasives (ethnologie)</term>
<term>Infections fongiques invasives (microbiologie)</term>
<term>Infections fongiques invasives (économie)</term>
<term>Itraconazole (usage thérapeutique)</term>
<term>Itraconazole (économie)</term>
<term>Techniques d'aide à la décision</term>
<term>Transplantation de cellules souches hématopoïétiques</term>
<term>Triazoles (usage thérapeutique)</term>
<term>Triazoles (économie)</term>
<term>Voriconazole (usage thérapeutique)</term>
</keywords>
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<term>Fluconazole</term>
<term>Itraconazole</term>
<term>Triazoles</term>
</keywords>
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<term>Fluconazole</term>
<term>Itraconazole</term>
<term>Triazoles</term>
<term>Voriconazole</term>
</keywords>
<keywords scheme="MESH" qualifier="economics" xml:lang="en"><term>Invasive Fungal Infections</term>
</keywords>
<keywords scheme="MESH" qualifier="ethnologie" xml:lang="fr"><term>Infections fongiques invasives</term>
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<keywords scheme="MESH" qualifier="ethnology" xml:lang="en"><term>Invasive Fungal Infections</term>
</keywords>
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</keywords>
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</keywords>
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<term>Fluconazole</term>
<term>Itraconazole</term>
<term>Triazoles</term>
<term>Voriconazole</term>
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<term>Itraconazole</term>
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<term>Humains</term>
<term>Infections fongiques invasives</term>
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<front><div type="abstract" xml:lang="en">Patients undergoing allogeneic haematopoietic stem cell transplantation (alloHSCT) are at risk of developing invasive fungal infections (IFIs). Even with introduction of oral triazole antifungal agents (fluconazole, itraconazole, posaconazole and voriconazole) IFI-associated morbidity and mortality rates and economic burden remain high. Despite their proven efficacy, it is currently unknown which is the most cost-effective antifungal prophylaxis (AFP) agent. To determine the costs and outcomes associated with AFP, a decision-analytic model was used to simulate treatment in a hypothetical cohort of 1000 patients undergoing alloHSCT from the perspective of the Spanish National Health System. Generic itraconazole was the least costly AFP (€162) relative to fluconazole (€500), posaconazole oral suspension (€8628) or voriconazole (€6850). Compared with posaconazole, voriconazole was associated with the lowest number of breakthrough IFIs (36 vs 60); thus, the model predicted fewer deaths from breakthrough IFI for voriconazole (24) than posaconazole (33), and the lowest predicted costs associated with other licensed antifungal treatment and IFI treatment in a cohort of 1000. Voriconazole resulted in cost savings of €4707 per patient compared with posaconazole. Itraconazole demonstrated a high probability of being cost-effective. As primary AFP in alloHSCT patients 180 days posttransplant, voriconazole was more likely to be cost-effective than posaconazole regarding cost per additional IFI and additional death avoided.</div>
</front>
</TEI>
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<DateCreated><Year>2016</Year>
<Month>08</Month>
<Day>26</Day>
</DateCreated>
<DateCompleted><Year>2017</Year>
<Month>03</Month>
<Day>23</Day>
</DateCompleted>
<DateRevised><Year>2017</Year>
<Month>03</Month>
<Day>23</Day>
</DateRevised>
<Article PubModel="Print-Electronic"><Journal><ISSN IssnType="Electronic">1439-0507</ISSN>
<JournalIssue CitedMedium="Internet"><Volume>60</Volume>
<Issue>2</Issue>
<PubDate><Year>2017</Year>
<Month>Feb</Month>
</PubDate>
</JournalIssue>
<Title>Mycoses</Title>
<ISOAbbreviation>Mycoses</ISOAbbreviation>
</Journal>
<ArticleTitle>Economic evaluation of azoles as primary prophylaxis for the prevention of invasive fungal infections in Spanish patients undergoing allogeneic haematopoietic stem cell transplant.</ArticleTitle>
<Pagination><MedlinePgn>79-88</MedlinePgn>
</Pagination>
<ELocationID EIdType="doi" ValidYN="Y">10.1111/myc.12552</ELocationID>
<Abstract><AbstractText>Patients undergoing allogeneic haematopoietic stem cell transplantation (alloHSCT) are at risk of developing invasive fungal infections (IFIs). Even with introduction of oral triazole antifungal agents (fluconazole, itraconazole, posaconazole and voriconazole) IFI-associated morbidity and mortality rates and economic burden remain high. Despite their proven efficacy, it is currently unknown which is the most cost-effective antifungal prophylaxis (AFP) agent. To determine the costs and outcomes associated with AFP, a decision-analytic model was used to simulate treatment in a hypothetical cohort of 1000 patients undergoing alloHSCT from the perspective of the Spanish National Health System. Generic itraconazole was the least costly AFP (€162) relative to fluconazole (€500), posaconazole oral suspension (€8628) or voriconazole (€6850). Compared with posaconazole, voriconazole was associated with the lowest number of breakthrough IFIs (36 vs 60); thus, the model predicted fewer deaths from breakthrough IFI for voriconazole (24) than posaconazole (33), and the lowest predicted costs associated with other licensed antifungal treatment and IFI treatment in a cohort of 1000. Voriconazole resulted in cost savings of €4707 per patient compared with posaconazole. Itraconazole demonstrated a high probability of being cost-effective. As primary AFP in alloHSCT patients 180 days posttransplant, voriconazole was more likely to be cost-effective than posaconazole regarding cost per additional IFI and additional death avoided.</AbstractText>
<CopyrightInformation>© 2016 The Authors. Mycoses Published by Blackwell Verlag GmbH.</CopyrightInformation>
</Abstract>
<AuthorList CompleteYN="Y"><Author ValidYN="Y"><LastName>Solano</LastName>
<ForeName>Carlos</ForeName>
<Initials>C</Initials>
<Identifier Source="ORCID">http://orcid.org/0000-0003-3702-0817</Identifier>
<AffiliationInfo><Affiliation>Hospital Clínico, INCLIVA-University of Valencia, Valencia, Spain.</Affiliation>
</AffiliationInfo>
</Author>
<Author ValidYN="Y"><LastName>Slavin</LastName>
<ForeName>Monica</ForeName>
<Initials>M</Initials>
<AffiliationInfo><Affiliation>Royal Melbourne Hospital, Melbourne, VIC, Australia.</Affiliation>
</AffiliationInfo>
</Author>
<Author ValidYN="Y"><LastName>Shaul</LastName>
<ForeName>Alissa J</ForeName>
<Initials>AJ</Initials>
<AffiliationInfo><Affiliation>Evidera, Bethesda, MD, USA.</Affiliation>
</AffiliationInfo>
</Author>
<Author ValidYN="Y"><LastName>Marks</LastName>
<ForeName>David I</ForeName>
<Initials>DI</Initials>
<AffiliationInfo><Affiliation>University Hospitals Bristol NHS Foundation Trust, Bristol, UK.</Affiliation>
</AffiliationInfo>
</Author>
<Author ValidYN="Y"><LastName>Cordonnier</LastName>
<ForeName>Catherine</ForeName>
<Initials>C</Initials>
<AffiliationInfo><Affiliation>Hôpital Henri Mondor, Assistance Publique-Hopitaux de Paris and UPEC, Creteil, France.</Affiliation>
</AffiliationInfo>
</Author>
<Author ValidYN="Y"><LastName>Cornely</LastName>
<ForeName>Oliver A</ForeName>
<Initials>OA</Initials>
<AffiliationInfo><Affiliation>Department I of Internal Medicine, Clinical Trials Centre Cologne, Centre for Integrated Oncology Köln Bonn, Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases, German Centre for Infection Research, University of Cologne, Cologne, Germany.</Affiliation>
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<Author ValidYN="Y"><LastName>Pagliuca</LastName>
<ForeName>Antonio</ForeName>
<Initials>A</Initials>
<AffiliationInfo><Affiliation>King's College Hospital, London, UK.</Affiliation>
</AffiliationInfo>
</Author>
<Author ValidYN="Y"><LastName>Cragin</LastName>
<ForeName>Lael</ForeName>
<Initials>L</Initials>
<AffiliationInfo><Affiliation>Evidera, Bethesda, MD, USA.</Affiliation>
</AffiliationInfo>
</Author>
<Author ValidYN="Y"><LastName>Jarque</LastName>
<ForeName>Isidro</ForeName>
<Initials>I</Initials>
<AffiliationInfo><Affiliation>Hospital Universitari i Politècnic La Fe, Valencia, Spain.</Affiliation>
</AffiliationInfo>
</Author>
<Author ValidYN="Y"><LastName>Garcia-Vidal</LastName>
<ForeName>Carolina</ForeName>
<Initials>C</Initials>
<AffiliationInfo><Affiliation>Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain.</Affiliation>
</AffiliationInfo>
</Author>
<Author ValidYN="Y"><LastName>Sorensen</LastName>
<ForeName>Sonja</ForeName>
<Initials>S</Initials>
<AffiliationInfo><Affiliation>Evidera, Bethesda, MD, USA.</Affiliation>
</AffiliationInfo>
</Author>
<Author ValidYN="Y"><LastName>Vanness</LastName>
<ForeName>David J</ForeName>
<Initials>DJ</Initials>
<AffiliationInfo><Affiliation>University of Wisconsin and Visiting Scientist at Evidera, Madison, WI, USA.</Affiliation>
</AffiliationInfo>
</Author>
<Author ValidYN="Y"><LastName>Charbonneau</LastName>
<ForeName>Claudie</ForeName>
<Initials>C</Initials>
<AffiliationInfo><Affiliation>Pfizer Inc, Paris, France.</Affiliation>
</AffiliationInfo>
</Author>
<Author ValidYN="Y"><LastName>Barrueta</LastName>
<ForeName>Jon Andoni</ForeName>
<Initials>JA</Initials>
<AffiliationInfo><Affiliation>Pfizer Inc, Madrid, Spain.</Affiliation>
</AffiliationInfo>
</Author>
<Author ValidYN="Y"><LastName>Peral</LastName>
<ForeName>Carmen</ForeName>
<Initials>C</Initials>
<AffiliationInfo><Affiliation>Pfizer Inc, Madrid, Spain.</Affiliation>
</AffiliationInfo>
</Author>
<Author ValidYN="Y"><LastName>De Salas-Cansado</LastName>
<ForeName>Marina</ForeName>
<Initials>M</Initials>
<AffiliationInfo><Affiliation>Pfizer Inc, Madrid, Spain.</Affiliation>
</AffiliationInfo>
</Author>
<Author ValidYN="Y"><LastName>Bow</LastName>
<ForeName>Eric J</ForeName>
<Initials>EJ</Initials>
<AffiliationInfo><Affiliation>CancerCare Manitoba, University of Manitoba, Winnipeg, MB, Canada.</Affiliation>
</AffiliationInfo>
</Author>
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<Language>eng</Language>
<PublicationTypeList><PublicationType UI="D023362">Evaluation Studies</PublicationType>
<PublicationType UI="D016428">Journal Article</PublicationType>
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<ArticleDate DateType="Electronic"><Year>2016</Year>
<Month>08</Month>
<Day>26</Day>
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<MedlineTA>Mycoses</MedlineTA>
<NlmUniqueID>8805008</NlmUniqueID>
<ISSNLinking>0933-7407</ISSNLinking>
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