PharmacoEconomics

, Volume 26, Issue 1, pp 75–90

Cost Effectiveness of Itraconazole in the Prophylaxis of Invasive Fungal Infections

  • Robin de Vries
  • Simon Daenen
  • Keith Tolley
  • Axel Glasmacher
  • Archie Prentice
  • Sarah Howells
  • Hariette Christopherson
  • Lolkje T. W. de Jong-van den Berg
  • Maarten J. Postma
Original Research Article

DOI: 10.2165/00019053-200826010-00007

Cite this article as:
de Vries, R., Daenen, S., Tolley, K. et al. Pharmacoeconomics (2008) 26: 75. doi:10.2165/00019053-200826010-00007

Abstract

Background

Invasive fungal infections in neutropenic patients treated for haematological malignancies are associated with a high mortality rate and, therefore, require early treatment. As the diagnosis of invasive fungal infections is difficult, effective antifungal prophylaxis is desirable. So far, fluconazole has been the most commonly used.

Objective

To assess the cost effectiveness of itraconazole compared with both fluconazole and no prophylaxis for the prevention of invasive fungal infections in haematological patients, mean age 51 years, in Germany and The Netherlands.

Study design

We designed a probabilistic decision model to fully incorporate the uncertainty associated with the risk estimates of acquiring an invasive fungal infection. These risk estimates were extracted from two meta-analyses, evaluating the effectiveness of fluconazole and itraconazole and no prophylaxis. The perspective of the analysis was that of the healthcare sector; only medical costs were taken into account. All costs were reported in €, year 2004 values.

Cost effectiveness was expressed as net costs per invasive fungal infection averted. No discounting was performed, as the model followed patients during their neutropenic period, which was assumed to be less than 1 year.

Results

According to our probabilistic decision model, the monetary benefits of averted healthcare exceed the costs of itraconazole prophylaxis under baseline assumptions (95% CI: from cost-saving to €5000 per invasive fungal infection averted). Compared with fluconazole, itraconazole is estimated to be both more effective and more economically favourable, with a probability of almost 98%.

Conclusions

In specific groups of neutropenic patients treated for haematological malignancies, itraconazole prophylaxis could potentially reduce overall healthcare expenditure, without harming effectiveness, in settings where fluconazole is common practice in the prophylaxis of invasive fungal infections.

Copyright information

© Adis Data Information BV 2008

Authors and Affiliations

  • Robin de Vries
    • 1
  • Simon Daenen
    • 2
  • Keith Tolley
    • 3
  • Axel Glasmacher
    • 4
  • Archie Prentice
    • 5
  • Sarah Howells
    • 3
  • Hariette Christopherson
    • 3
  • Lolkje T. W. de Jong-van den Berg
    • 1
  • Maarten J. Postma
    • 1
  1. 1.Groningen Research Institute of Pharmacy (GRIP)University of GroningenGroningenThe Netherlands
  2. 2.University Medical Centre Groningen (UMCG)GroningenThe Netherlands
  3. 3.Ortho BiotechHigh WycombeUK
  4. 4.University Hospital BonnBonnGermany
  5. 5.Derriford HospitalPlymouthUK

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