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Cost-effectiveness of posaconazole tablets versus fluconazole as prophylaxis for invasive fungal diseases in patients with graft-versus-host disease after allogeneic hematopoietic stem cell transplantation

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Abstract

Background

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.

Objectives

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.

Methodology

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.

Results

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.

Conclusions

Posaconazole tablets are a cost-effective alternative to fluconazole and may show better results than the oral suspension formulation.

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Acknowledgements

The study was funded by MSD Sharp & Dohme.

Author information

Authors and Affiliations

  1. Pharmacy Department, Del Mar Hospital, Barcelona, Spain

    Santiago Grau

  2. La Princesa Hospital, Calle de Diego de León, 62, 28006, Madrid, Spain

    Rafael Cámara

  3. Virgen de las Nieves University Hospital, Granada, Spain

    Manuel Jurado

  4. La Fe University Hospital, Valencia, Spain

    Jaime Sanz

  5. Merck Sharp & Dohme Corp., Madrid, Spain

    Belén Aragón

  6. Outcomes10, Castellon, Spain

    Irmina Gozalbo

Authors
  1. Santiago Grau
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  2. Rafael Cámara
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Corresponding author

Correspondence to Rafael Cámara.

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Conflict of interests

The authors RC, MJ, JS, and SG declare they have no conflict of interest. BA works at MSD Sharp & Dohme. IG works for an independent research institution and received payment for her contribution to the development of the project as well as to the drafting of this manuscript.

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Grau, S., Cámara, R., Jurado, M. et al. Cost-effectiveness of posaconazole tablets versus fluconazole as prophylaxis for invasive fungal diseases in patients with graft-versus-host disease after allogeneic hematopoietic stem cell transplantation. Eur J Health Econ 19, 627–636 (2018). https://doi.org/10.1007/s10198-017-0907-5

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  • DOI: https://doi.org/10.1007/s10198-017-0907-5

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