Cost-effectiveness of posaconazole versus fluconazole or itraconazole in the prevention of invasive fungal infections among high-risk neutropenic patients in Spain

A decision-analytic model, based on a randomised phase III trial, was used to predict IFI avoided, life-years saved (LYS), total costs, and incremental cost-effectiveness ratio (ICER; incremental cost per LYS) over patients' lifetime horizon. Data for the analyses included life expectancy, procedures, and costs associated with IFI and the drugs (in euros at November 2009 values) which were obtained from the published literature and opinions of an expert committee. A probabilistic sensitivity analysis (PAS) was performed.Posaconazole was associated with fewer IFI (0.05 versus 0.11), increased LYS (2.52 versus 2.43), and significantly lower costs excluding costs of the underlying condition (€6,121 versus €7,928) per patient relative to SAT. There is an 85% probability that posaconazole is a cost-saving strategy compared to SAT and a 97% probability that the ICER for posaconazole relative to SAT is below the cost per LYS threshold of €30,000 currently accepted in Spain.Posaconazole is a cost-saving prophylactic strategy (lower costs and greater efficacy) compared with fluconazole or itraconazole in high-risk neutropenic patients.Patients with neutropenia as a result of chemotherapy for acute myelogenous leukaemia (AML) or myelodysplastic syndrome (MDS) are at high risk of developing invasive fungal infection (IFI) [1-7]. Early diagnosis and treatment of IFI are difficult and, as such, are associated with high mortality rates in neutropenic patients. Hence, prophylaxis of IFI has become a commonly used strategy to reduce overall morbidity-mortality rates in patients with haematologic malignancies [8].Posaconazole is a new-generation oral azole [9] that has been demonstrated to be superior to standard azole therapy (SAT; fluconazole or itraconazole) in preventing IFI and reducing overall mortality in high-risk neutropenic patients [10]. In a recent study, posaconazol was shown not only to be as efficacious as fluconazole in the prevention of IFI but also superior to fluc