JAC Advance Access originally published online on February 22, 2005
Journal of Antimicrobial Chemotherapy 2005 55(3):352-361; doi:10.1093/jac/dkh535
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JAC vol.55 no.3 © The British Society for Antimicrobial Chemotherapy 2005; all rights reserved
Economic evaluation of voriconazole compared with conventional amphotericin B for the primary treatment of aspergillosis in immunocompromised patients
1 Department of Internal Medicine, Medical College of Virginia, Virginia Commonwealth University, Old City Hall, 1001 East Broad Street, 4th Floor Suite 405, P.O. Box 980663, Richmond, VA 23298-0663; 6 RTI Health Solutions, Research Triangle Park, NC; 8 Pfizer Inc, New York, USA; 5 Hamilton Health Sciences, Hamilton, Ontario, Canada; 2 Institute of Internal Medicine and Oncology, University of Perugia, Perugia, Italy; 3 Department of Medical Microbiology, Royal Free Hospital, London; 4 Department of Infectious Diseases, Imperial College, Hammersmith Hospital, London; 7 Department of Health Economics, Imperial College Management School, London; 9 Pfizer Ltd, Sandwich, UK
* Corresponding author. Tel: +1-804-828-3389; Fax: +1-804-828-5566; Email: rwenzel{at}hsc.vcu.edu
Objective: The objective of this study was to conduct an economic evaluation of voriconazole compared with conventional amphotericin B deoxycholate (CAB) using data from a recently reported randomized comparative trial in patients with various underlying immunosuppressive conditions. This trial demonstrated the superiority of voriconazole in terms of clinical response, survival and safety when used as primary therapy for invasive aspergillosis.
Methods: A decision analytic model was designed using an expert panel and populated primarily with efficacy and resource utilization data collected prospectively during the clinical trial. The analysis was carried out from the perspective of the health care system and all costs are reported in 2002 US dollars.
Results: Average total treatment costs per patient were 10% lower in the voriconazole arm ($30 664) than in the CAB arm ($34 144), resulting from reduced consumption of hospital resources and fewer changes in antifungal therapy. In the base case analysis, voriconazole provided an average saving of $3481 per treated patient, resulted in a lower cost per survivor ($43 310 versus $58 971) and a lower cost per successfully treated patient ($58 100 versus $108 124) compared with CAB. Sensitivity analyses demonstrated that the cost savings observed were maintained over a wide range of alternative values for both unit costs and resource utilization, including length of hospital stay, time spent in intensive care units, bed day costs and the cost of lipid formulations of amphotericin B.
Conclusion: Incremental cost-effectiveness analysis indicated the dominance of voriconazole because of both lower costs and greater efficacy.
Keywords: RCT , cost-effectiveness , model , sensitivity analyses
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