Clinical and Economical Expediency of Posaconazole Comparing with Fluconazole and Itraconazole in Primary Prophylaxis of Systemic Mycoses in Severe Neutropenic Patients

Abstract

For the first time in Russian economic conditions and with use of mathematic modeling, clinical-economic study of posaconazole in comparison with fluconazole/itraconazole for primary prophylaxis of invasive mycoses in patients with severe neutropenia due to acute myeloid leukemia or myelodysplastic syndrome was conducted. The total costs, consisted of costs of the prophylaxis and treatment of invasive mycoses, was calculated taking into consideration the rate of fungal infections and the number of saved life years in each prophylaxis group. As a result it has been shown that the mean cost of the treatment of invasive fungal infections (calculated as arithmetic mean of costs of voriconazole, caspofungin and amphotericin B lipid complex used for the treatment of fungal infections) in posaconazole prophylaxis group was 5.6% lower in comparison with fluconazole/itraconazole group. In detailed analysis of expenses structure the direct cost of posaconazole prophylaxis was 12.9 times higher than in fluconazole/itraconazole group due to higher price of pozaconazole. But at the same time total cost of the treatment of fungal infectious complications in posaconazole group was 2.2 times lower than in fluconazole/itraconazole group due to lower incidence of development of fungal infections. Analysis of main scenario is advising that the regimen of prophylaxis containing posaconazole is overall cost-effective in comparison with conventional fluconazole/itraconazole regimens. One-sided sensitivity analysis has shown that the rate of development of fungal infections during the pozaconazole prophylaxis has greater influence on costs incremental coefficient than direct costs of prophylactic antifungals.