Objectives: This study evaluated cost-effectiveness of posaconazole versus standard azole therapy (SAT; fluconazole or itraconazole) for prevention of invasive fungal infection (IFI) in neutropenic patients from the Thai health care system perspective.

Methods: A decision-analytic model was developed based on data from clinical trials. The surviving patients in the decision tree were extrapolated to a lifetime horizon using Markov model in which mortality risk was specific to underlying disease. The rates of IFI, IFI-related mortality, overall mortality and treatment duration were obtained from published literature. The probability of IFI-related death of posaconazole was assumed to be equal to SAT for Scenario I (45%), and was lower than SAT for Scenario II (36% vs. 48%) as obtained from clinical trial. Data of IFI-related costs and health care resource utilization were obtained from local studies and expert opinion. Drug prices were those published by Ministry of Public Health. All costs were expressed in THB 2013 values. Future costs and outcomes were discounted at 3%. The model outcomes included costs, IFI avoided, life years saved (LYS) and incremental cost-effectiveness ratio (ICER) of posaconazole versus SAT.

Results: In comparison with fluconazole/itraconazole, posaconazole was associated with fewer IFIs per patient (0.05 vs. 0.11) during 100-day follow-up. Over a lifetime horizon, prophylaxis with posaconazole resulted in lower discounted costs and a benefit of 0.06 and 0.07 in terms of discounted LYS for Scenario I and II, respectively. The probabilistic sensitivity analyses showed that there are 95.9% and 96.4% probabilities that posaconazole is cost-effective relative to fluconazole/itraconazole at the recommended threshold of 160,000 THB/LYS for such comparisons.

Conclusions: This analysis suggested that posaconazole is the dominant treatment strategy (more effective and less costly) for the prevention of IFI in patients with prolonged neutropenia in Thailand. Posaconazole prophylaxis may substantial diminish for the economic burden of IFI.