Comparative cost-effectiveness analysis of voriconazole and fluconazole for prevention of invasive fungal infection in patients receiving allogeneic hematopoietic cell transplants

Josephine Mauskopf, Costel Chirila, Jon Graham, Iris D. Gersten, Helen Leather, Richard Maziarz, Lindsey R. Baden, Javier Bolaños-Meade, Janice M Y Brown, Thomas J. Walsh, Mary H. Horowitz, Joanne Kurtzberg, Kieren A. Marr, John R. Wingard

Research output: Contribution to journalArticle

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Abstract

Purpose. The cost-effectiveness of voriconazole versus fluconazole prophylaxis against fungal infections in hematopoietic cell transplant (HCT) recipients is investigated. Methods. A decision-analytic model was developed to estimate the drug costs associated with planned or supplemental prophylaxis and empirical therapy and the costs of treating suspected or documented invasive fungal infections (IFIs) in HCT recipients. Published clinical trial data on 599 patients who received 100-180 days of prophylactic therapy with voriconazole or fluconazole were used to model specified IFI-prevention and mortality outcomes; 6-month, 12-month, and lifetime incremental cost-effectiveness ratios (ICERs) were estimated, with a bootstrap analysis performed to reflect the uncertainty of the clinical trial data. Results. Estimated mean total prophylaxis and IFI-related costs associated with voriconazole versus fluconazole prophylaxis over 12 months were higher in the entire study population and among patients receiving HCT for diagnoses other than acute myeloid leukemia (AML) but were not significantly different for patients with AML. The cost per IFI avoided ($66,919) and the cost per life-year gained ($5,453) were lower among patients with AML who received voriconazole relative to the full study population. ICERs were more favorable for voriconazole over a 6-month time frame and when modeling was conducted using generic price data. Assuming a threshold value of $50,000 for one year of life gained, the calculated probability of voriconazole being cost-effective was 33% for the full study population and 85% for the AML subgroup. Conclusion. The decision model indicated that voriconazole prophylaxis was costeffective for patients undergoing allogeneic HCT for AML.

Original languageEnglish (US)
Pages (from-to)1518-1527
Number of pages10
JournalAmerican Journal of Health-System Pharmacy
Volume70
Issue number17
DOIs
StatePublished - Sep 1 2013

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Fluconazole
Cost-Benefit Analysis
Acute Myeloid Leukemia
Transplants
Costs and Cost Analysis
Clinical Trials
Population
Drug Costs
Mycoses
Voriconazole
Invasive Fungal Infections
Uncertainty
Mortality
Therapeutics

ASJC Scopus subject areas

  • Pharmacology
  • Health Policy
  • Medicine(all)

Cite this

Comparative cost-effectiveness analysis of voriconazole and fluconazole for prevention of invasive fungal infection in patients receiving allogeneic hematopoietic cell transplants. / Mauskopf, Josephine; Chirila, Costel; Graham, Jon; Gersten, Iris D.; Leather, Helen; Maziarz, Richard; Baden, Lindsey R.; Bolaños-Meade, Javier; Brown, Janice M Y; Walsh, Thomas J.; Horowitz, Mary H.; Kurtzberg, Joanne; Marr, Kieren A.; Wingard, John R.

In: American Journal of Health-System Pharmacy, Vol. 70, No. 17, 01.09.2013, p. 1518-1527.

Research output: Contribution to journalArticle

Mauskopf, J, Chirila, C, Graham, J, Gersten, ID, Leather, H, Maziarz, R, Baden, LR, Bolaños-Meade, J, Brown, JMY, Walsh, TJ, Horowitz, MH, Kurtzberg, J, Marr, KA & Wingard, JR 2013, 'Comparative cost-effectiveness analysis of voriconazole and fluconazole for prevention of invasive fungal infection in patients receiving allogeneic hematopoietic cell transplants', American Journal of Health-System Pharmacy, vol. 70, no. 17, pp. 1518-1527. https://doi.org/10.2146/ajhp120599
Mauskopf, Josephine ; Chirila, Costel ; Graham, Jon ; Gersten, Iris D. ; Leather, Helen ; Maziarz, Richard ; Baden, Lindsey R. ; Bolaños-Meade, Javier ; Brown, Janice M Y ; Walsh, Thomas J. ; Horowitz, Mary H. ; Kurtzberg, Joanne ; Marr, Kieren A. ; Wingard, John R. / Comparative cost-effectiveness analysis of voriconazole and fluconazole for prevention of invasive fungal infection in patients receiving allogeneic hematopoietic cell transplants. In: American Journal of Health-System Pharmacy. 2013 ; Vol. 70, No. 17. pp. 1518-1527.
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abstract = "Purpose. The cost-effectiveness of voriconazole versus fluconazole prophylaxis against fungal infections in hematopoietic cell transplant (HCT) recipients is investigated. Methods. A decision-analytic model was developed to estimate the drug costs associated with planned or supplemental prophylaxis and empirical therapy and the costs of treating suspected or documented invasive fungal infections (IFIs) in HCT recipients. Published clinical trial data on 599 patients who received 100-180 days of prophylactic therapy with voriconazole or fluconazole were used to model specified IFI-prevention and mortality outcomes; 6-month, 12-month, and lifetime incremental cost-effectiveness ratios (ICERs) were estimated, with a bootstrap analysis performed to reflect the uncertainty of the clinical trial data. Results. Estimated mean total prophylaxis and IFI-related costs associated with voriconazole versus fluconazole prophylaxis over 12 months were higher in the entire study population and among patients receiving HCT for diagnoses other than acute myeloid leukemia (AML) but were not significantly different for patients with AML. The cost per IFI avoided ($66,919) and the cost per life-year gained ($5,453) were lower among patients with AML who received voriconazole relative to the full study population. ICERs were more favorable for voriconazole over a 6-month time frame and when modeling was conducted using generic price data. Assuming a threshold value of $50,000 for one year of life gained, the calculated probability of voriconazole being cost-effective was 33{\%} for the full study population and 85{\%} for the AML subgroup. Conclusion. The decision model indicated that voriconazole prophylaxis was costeffective for patients undergoing allogeneic HCT for AML.",
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T1 - Comparative cost-effectiveness analysis of voriconazole and fluconazole for prevention of invasive fungal infection in patients receiving allogeneic hematopoietic cell transplants

AU - Mauskopf, Josephine

AU - Chirila, Costel

AU - Graham, Jon

AU - Gersten, Iris D.

AU - Leather, Helen

AU - Maziarz, Richard

AU - Baden, Lindsey R.

AU - Bolaños-Meade, Javier

AU - Brown, Janice M Y

AU - Walsh, Thomas J.

AU - Horowitz, Mary H.

AU - Kurtzberg, Joanne

AU - Marr, Kieren A.

AU - Wingard, John R.

PY - 2013/9/1

Y1 - 2013/9/1

N2 - Purpose. The cost-effectiveness of voriconazole versus fluconazole prophylaxis against fungal infections in hematopoietic cell transplant (HCT) recipients is investigated. Methods. A decision-analytic model was developed to estimate the drug costs associated with planned or supplemental prophylaxis and empirical therapy and the costs of treating suspected or documented invasive fungal infections (IFIs) in HCT recipients. Published clinical trial data on 599 patients who received 100-180 days of prophylactic therapy with voriconazole or fluconazole were used to model specified IFI-prevention and mortality outcomes; 6-month, 12-month, and lifetime incremental cost-effectiveness ratios (ICERs) were estimated, with a bootstrap analysis performed to reflect the uncertainty of the clinical trial data. Results. Estimated mean total prophylaxis and IFI-related costs associated with voriconazole versus fluconazole prophylaxis over 12 months were higher in the entire study population and among patients receiving HCT for diagnoses other than acute myeloid leukemia (AML) but were not significantly different for patients with AML. The cost per IFI avoided ($66,919) and the cost per life-year gained ($5,453) were lower among patients with AML who received voriconazole relative to the full study population. ICERs were more favorable for voriconazole over a 6-month time frame and when modeling was conducted using generic price data. Assuming a threshold value of $50,000 for one year of life gained, the calculated probability of voriconazole being cost-effective was 33% for the full study population and 85% for the AML subgroup. Conclusion. The decision model indicated that voriconazole prophylaxis was costeffective for patients undergoing allogeneic HCT for AML.

AB - Purpose. The cost-effectiveness of voriconazole versus fluconazole prophylaxis against fungal infections in hematopoietic cell transplant (HCT) recipients is investigated. Methods. A decision-analytic model was developed to estimate the drug costs associated with planned or supplemental prophylaxis and empirical therapy and the costs of treating suspected or documented invasive fungal infections (IFIs) in HCT recipients. Published clinical trial data on 599 patients who received 100-180 days of prophylactic therapy with voriconazole or fluconazole were used to model specified IFI-prevention and mortality outcomes; 6-month, 12-month, and lifetime incremental cost-effectiveness ratios (ICERs) were estimated, with a bootstrap analysis performed to reflect the uncertainty of the clinical trial data. Results. Estimated mean total prophylaxis and IFI-related costs associated with voriconazole versus fluconazole prophylaxis over 12 months were higher in the entire study population and among patients receiving HCT for diagnoses other than acute myeloid leukemia (AML) but were not significantly different for patients with AML. The cost per IFI avoided ($66,919) and the cost per life-year gained ($5,453) were lower among patients with AML who received voriconazole relative to the full study population. ICERs were more favorable for voriconazole over a 6-month time frame and when modeling was conducted using generic price data. Assuming a threshold value of $50,000 for one year of life gained, the calculated probability of voriconazole being cost-effective was 33% for the full study population and 85% for the AML subgroup. Conclusion. The decision model indicated that voriconazole prophylaxis was costeffective for patients undergoing allogeneic HCT for AML.

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