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Cost Effectiveness of Itraconazole in the Prophylaxis of Invasive Fungal Infections

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Author Info

  • Robin de Vries

    (Groningen Research Institute of Pharmacy (GRIP), University of Groningen, Groningen, The Netherlands)

  • Simon Daenen

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

  • Keith Tolley

    (Ortho Biotech, High Wycombe, UK)

  • Axel Glasmacher

    (University Hospital Bonn, Bonn, Germany)

  • Archie Prentice

    (Derriford Hospital, Plymouth, UK)

  • Sarah Howells

    (Ortho Biotech, High Wycombe, UK)

  • Hariette Christopherson

    (Ortho Biotech, High Wycombe, UK)

  • Lolkje T.W. de Jong-van den Berg

    (Groningen Research Institute of Pharmacy (GRIP), University of Groningen, Groningen, The Netherlands)

  • Maarten J. Postma

    (Groningen Research Institute of Pharmacy (GRIP), University of Groningen, Groningen, The Netherlands)

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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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    Bibliographic Info

    Article provided by Springer Healthcare | Adis in its journal PharmacoEconomics.

    Volume (Year): 26 (2008)
    Issue (Month): 1 ()
    Pages: 75-90
    Download reference. The following formats are available: HTML (with abstract), plain text (with abstract), BibTeX, RIS (EndNote, RefMan, ProCite), ReDIF
    Handle: RePEc:wkh:phecon:v:26:y:2008:i:1:p:75-90

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    Web page: http://pharmacoeconomics.adisonline.com/

    For corrections or technical questions regarding this item, or to correct its listing, contact: (Dave Dustin).

    Related research

    Keywords: Aspergillosis; Aspergillosis; Candidiasis; Candidiasis; Cost-effectiveness; Fluconazole; Haematological-malignancies; Itraconazole; Mycoses; Mycoses;

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