The cost–utility analysis of antifungal prophylaxis for invasive fungal infections in acute myeloid leukaemia patients receiving chemotherapy: a study from a middle-income country
Issued Date
2024-03-01
Resource Type
ISSN
01956701
eISSN
15322939
Scopus ID
2-s2.0-85184004572
Pubmed ID
38219835
Journal Title
Journal of Hospital Infection
Volume
145
Start Page
118
End Page
128
Rights Holder(s)
SCOPUS
Bibliographic Citation
Journal of Hospital Infection Vol.145 (2024) , 118-128
Suggested Citation
Pungprasert T., Dhirachaikulpanich D., Phutthasakda W., Tantai N., Maneeon S., Nganthavee V., Atipas K., Tanpong S., Krithin S., Tanglitanon S., Jutidamrongphan W., Chayakulkeeree M., Srinonprasert V., Phikulsod P. The cost–utility analysis of antifungal prophylaxis for invasive fungal infections in acute myeloid leukaemia patients receiving chemotherapy: a study from a middle-income country. Journal of Hospital Infection Vol.145 (2024) , 118-128. 128. doi:10.1016/j.jhin.2023.12.013 Retrieved from: https://repository.li.mahidol.ac.th/handle/20.500.14594/97122
Title
The cost–utility analysis of antifungal prophylaxis for invasive fungal infections in acute myeloid leukaemia patients receiving chemotherapy: a study from a middle-income country
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Abstract
Background: Invasive fungal infections (IFIs) contribute to morbidity and mortality during acute myeloid leukaemia (AML) treatment. Without prophylaxis, IFI rate during AML treatment in Thailand is high and results in a high mortality rate and a prolonged hospital stay. Aim: To evaluate the cost–utility of antifungal therapy (AFT) prophylaxis during AML treatment. Methods: We assessed the cost–utility of AFT available in Thailand, including posaconazole (solution), itraconazole (solution and capsule), and voriconazole. A hybrid model consisting of a decision tree and the Markov model was established. Results: The costs to prevent overall IFI using any AFT were all lower than the treatment cost of a non-prophylaxis group, resulting in a saving of 808–1507 USD per patient. Prevention with voriconazole prophylaxis showed the highest quality-adjusted life years (QALYs = 3.51, incremental QALYs = 0.23), followed by posaconazole (QALYs = 3.46, incremental QALY = 0.18) and itraconazole solution (QALYs = 3.45, incremental QALYs = 0.17). Itraconazole capsule reduced QALY in the model. For invasive aspergillosis prevention, posaconazole and voriconazole both resulted in better QALYs and life year savings compared with no prophylaxis. However, posaconazole prophylaxis was the only cost-saving option (976 USD per patient). Conclusion: Posaconazole, itraconazole solution and voriconazole were all cost saving compared with no prophylaxis for overall IFI prophylaxis, with voriconazole being the most cost-effective option. Posaconazole and voriconazole were both cost effective for invasive aspergillosis prevention but only posaconazole was cost saving. A change in reimbursement policy for the use of AFT prophylaxis during intensive AML treatment could provide both clinical benefits to patients and substantial economic benefits to healthcare systems.