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Cost Effectiveness of Itraconazole in the Prophylaxis of Invasive Fungal Infections

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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.

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Notes

  1. The use of trade names is for product identification purposes only and does not imply endorsement.

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Acknowledgements

This study was supported by a grant from Ortho Biotech. The co-authors from Ortho Biotech had an important contribution in conceiving and planning the project and in specific tasks (e.g. disseminating the questionnaire). The sponsor had no role in the data analysis and interpretation of the results. The authors from academic institutions retained the right to publish the data regardless of the outcomes. The sponsor did comment on various versions of the manuscripts, including the final version. Axel Glasmacher and Archie Prentice have previously received grants, honoraria and/or consultancy fees from Ortho Biotech and Pfizer.

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Authors and Affiliations

  1. Groningen Research Institute of Pharmacy (GRIP), University of Groningen, Antonius Deusinglaan 1, Groningen, 9713 AV, The Netherlands

    Robin de Vries, Lolkje T. W. de Jong-van den Berg & Maarten J. Postma

  2. University Medical Centre Groningen (UMCG), Groningen, The Netherlands

    Simon Daenen

  3. Ortho Biotech, High Wycombe, UK

    Keith Tolley, Sarah Howells & Hariette Christopherson

  4. University Hospital Bonn, Bonn, Germany

    Axel Glasmacher

  5. Derriford Hospital, Plymouth, UK

    Archie Prentice

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  1. Robin de Vries
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  2. Simon Daenen
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  4. Axel Glasmacher
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Correspondence to Robin de Vries.

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de Vries, R., Daenen, S., Tolley, K. et al. Cost Effectiveness of Itraconazole in the Prophylaxis of Invasive Fungal Infections. Pharmacoeconomics 26, 75–90 (2008). https://doi.org/10.2165/00019053-200826010-00007

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