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Open Access Research article

Pharmacoeconomic evaluation of voriconazole vs. liposomal amphotericin B in empiric treatment of invasive fungal infections in Turkey

Stuart J Turner1, Esin Senol2, Ates Kara3, Daoud Al-Badriyeh4, Ener C Dinleyici5* and David CM Kong6*

Author Affiliations

1 Department of Pharmacy Practice and Administration, Ernest Mario School of Pharmacy, Rutgers University, New Jersey, USA

2 Department of Infectious Disease, Gazi University, Ankara, Turkey

3 Department of Pediatric Infectious Disease, Hacettepe University, Ankara, Turkey

4 College of Pharmacy, Qatar University, Doha, Qatar

5 Department of Pediatrics, Pediatric Intensive Care and Pediatric Infectious Disease, Faculty of Medicine, Eskisehir Osmangazi University, Eskisehir 26480, Turkey

6 Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University (Parkville Campus), 381 Royal Parade, Parkville, Victoria 3052, Australia

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BMC Infectious Diseases 2013, 13:560  doi:10.1186/1471-2334-13-560

Published: 26 November 2013

Abstract

Background

Invasive fungal infections (IFI) are associated with considerable expense and mortality on healthcare systems. There is a need to provide evidence of both clinical efficacy and value for money with any health technology. The current pharmacoeconomic evaluation investigated the use of liposomal amphotericin B (LAmB) and voriconazole for the empiric treatment of IFI in the Turkish setting.

Methods

Decision analytic modelling was used to create a pathway for patient treatment with a 5-point composite outcome measure. The data was obtained from a major non-inferiority multicentre randomised controlled study, with an expert panel of clinicians in Turkey providing transition probabilities and cost not available in the literature. Sensitivity analyses were performed on the inputs from the clinical trial and the expert panel.

Results

As per the base case analysis, voriconazole was preferred by Turkish Lira (TL) 2,523 per patient treated and TL2,520 per surviving patient. LAmB was the preferred alternative by TL5,362 per successfully treated patient. Removing fever resolution as part of the composite outcome measure resulted in voriconazole being the preferred alternative per successfully treated patient. Univariate sensitivity analysis highlighted that increasing the duration of voriconazole by >1.2 days or decreasing LAmB by >1.0 days changes the result. Monte Carlo Simulation resulted in 69.4% of simulations favouring voriconazole per patient treated.

Conclusion

There is a strong likelihood that voriconazole is economically more favourable than LAmB in the empiric treatment of IFI in Turkey.

Keywords:
Antifungal agents; Voriconazole; Liposomal amphotericin B; Economic evaluation; Invasive fungal infection; Empiric therapy