Economic Evaluation of Voriconazole versus Caspofungin for the Treatment of Invasive Aspergillosis in Spain

摘要

Background and objective: Invasive fungal infections are becoming increasingly prevalent and are more frequently the aetiological agents responsible for nosocomial infections. Since mid-2002, two new antifungal drugs - voriconazole, a third-generation azole, and caspofungin, a member of a new class of drugs called echinocandins - have been marketed in Spain. Both drugs have greater efficacy (because of their specific mechanisms of action), more favourable toxicity profiles and are much less costly than liposomal amphotericin B. The objective of this study was to conduct an economic evaluation of voriconazole versus caspofungin for the treatment of invasive aspergillosis in Spain. Methods: This was a cost-minimisation analysis (2006 costs) from the hospital perspective. Duration of treatment and body weight of patients were obtained from the Fungcost study and the incidence of adverse events was obtained from different published sources. Only direct costs were considered. Mean expected cost and incremental cost were calculated, and univariate and bivariate (bodyweight/treatment duration) sensitivity analyses were conducted. Results: The mean expected cost per episode was E6041.93 (intravenous treatment acquisition cost E5524.75) for voriconazole and E7174.05 (intravenous treatment acquisition cost E6672.80) for caspofungin in invasive aspergillosis; the incremental cost was E1132.18. Results were robust for any treatment duration and sensitive to body weights < 103.42kg. Conclusion: Voriconazole is a more cost-effective option than caspofungin in invasive aspergillosis in patients with a body weight < 103.42kg.