ClinicoEconomics and Outcomes Research (Sep 2018)
Cost-effectiveness analysis of voriconazole, fluconazole, and amphotericin B for invasive fungal infections following allogeneic hematopoietic stem cell transplantation in Mexico
Abstract
Rayo Morfín-Otero,1,2 Martha Alvarado-Ibarra,3 Eduardo Rodriguez-Noriega,1,2 Jesus Resendiz-Sanchez,4 Dipen A Patel,5 Jennifer M Stephens,5 Manuela Di Fusco,6 Carlos F Mendoza,6 Claudie Charbonneau7 1Institute of Infectious and Experimental Pathology, University Center for Health Science, University of Guadalajara, Guadalajara, Jalisco, Mexico; 2Division of Infectious Diseases, Civil Hospital of Guadalajara, Fray Antonio Alcalde, Guadalajara, Jalisco, Mexico; 3Hematology Service, National Medical Center ‘November 20’, Mexico City, Mexico; 4Laboratory of Mycology, Children’s Hospital of Mexico, Mexico City, Mexico; 5Pharmerit International, Bethesda, MD, USA; 6Pfizer Inc, Mexico City, Mexico; 7Pfizer International Operations, Paris, Île-de-France, France Background: Patients receiving allogeneic hematopoietic stem cell transplantation (alloHSCT) are at high risk of invasive fungal infections (IFIs), which are associated with high mortality and economic burden. The cost-effectiveness of prophylaxis for the prevention of IFIs in alloHSCT recipients in Mexico has not yet been assessed. Methods: This analysis modeled a hypothetical cohort of 1,000 patients to estimate costs and outcomes for patients receiving prophylaxis for IFIs following alloHSCT, from the perspective of institutional payers in Mexico. The main prophylaxis agents currently used in Mexican clinical practice are voriconazole, fluconazole, and amphotericin B (AmB). The model accounted for event rates of IFIs during each treatment, assuming IFI causality due to invasive aspergillosis, invasive candidiasis, or other IFIs, and that the outcome for patients during follow-up was IFI-related death, death from other causes, or survival. Clinical efficacies were obtained from published literature; costs were based on local sources. Cost-effectiveness was assessed using incremental cost-effectiveness ratios (ICERs). Univariate (assessing the impact of varying each model parameter) and probabilistic sensitivity analyses were performed. Results: Voriconazole was associated with the lowest number of breakthrough IFIs, IFI-related deaths, and total number of deaths. Total costs were lower for fluconazole (Mexican pesos [MXN] 72,944; US $4,079) than voriconazole (MXN 101,413; US $5,671) or AmB (MXN 110,529; US $6,180). Voriconazole had better clinical outcomes and lower costs than AmB and could be considered cost-effective compared with fluconazole in line with the local ICER threshold. Drug costs, monitoring costs, and duration of prophylaxis were most sensitive to variation from univariate sensitivity analysis. Findings from the probabilistic sensitivity analysis were consistent with the base-case results. Conclusion: Voriconazole had the most favorable clinical outcomes, but overall prophylaxis costs were higher than with fluconazole. Overall, based on local ICER thresholds (MXN 184,665; US $10,326), voriconazole was considered a cost-effective option for prophylaxis of IFI in Mexico. Keywords: allogeneic hematopoietic stem cell transplantation, triazole, invasive aspergillosis, invasive candidiasis, incremental cost-effectiveness ratio, prophylaxis
