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Pharmacoeconomic assessment of therapy for invasive aspergillosis

Me-Linh Luong1, Shahid Husain, Coleman Rotstein

  • 1Division of Infectious Diseases, Department of Medicine, University of Toronto, University Health Network, Toronto, Ontario, Canada.

Mycoses
|January 15, 2013
PubMed

Insights

Voriconazole is cost-effective for invasive aspergillosis (IA) primary treatment. Posaconazole is the most cost-effective for antifungal prophylaxis, while voriconazole and caspofungin show cost-effectiveness for empiric therapy.

Area of Science:

  • Medical Mycology
  • Health Economics
  • Infectious Diseases

Background:

  • Invasive aspergillosis (IA) significantly contributes to morbidity and mortality in immunocompromised individuals.
  • Economic expenditures associated with invasive fungal infections (IFIs), including IA, are substantial.
  • Hospitalization duration and costs are major cost drivers, but newer oral antifungals may alter this.

Purpose of the Study:

  • To review pharmacoeconomic (PE) studies on antifungal agents for invasive aspergillosis (IA).
  • To focus on primary therapy, salvage therapy, empiric therapy, and prophylaxis for IA.
  • To evaluate the cost-effectiveness of different antifungal strategies.

Main Methods:

  • Systematic review of pharmacoeconomic (PE) studies.
  • Analysis of cost-effectiveness and dominance of antifungal agents.
  • Comparison of agents for primary, salvage, empiric therapy, and prophylaxis of IA.

Main Results:

  • Voriconazole is cost-effective and dominant for targeted primary treatment of IA.
  • For empiric therapy, voriconazole and caspofungin appear cost-effective over liposomal amphotericin B (LAmB).
  • Posaconazole demonstrates the highest cost-effectiveness for antifungal prophylaxis against IFIs and IA.

Conclusions:

  • Pharmacoeconomic evaluations support voriconazole for primary IA treatment.
  • Caspoofungin and voriconazole are cost-effective empiric options, while LAmB is more expensive than conventional amphotericin B.
  • Posaconazole is the preferred agent for cost-effective antifungal prophylaxis in at-risk populations.

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