1672. Cost-effectiveness analysis of empiric liposomal amphotericin B vs. voriconazole in Turkey
Session: Poster Abstract Session: Pre-emptive Therapy in Transplantation and Immunocompromised Hosts
Saturday, October 5, 2013
Room: The Moscone Center: Poster Hall C
Background: A pivotal clinical trial failed to demonstrate non-inferiority of voriconazole (VORI) vs. liposomal amphotericin B (LAMB) for empiric treatment of febrile neutropaenia (FN). This study investigated the cost-effectiveness of the two options from the Turkish health care system perspective.

Methods: A decision-tree analysis was used to capture downstream consequences of each agent. Outcome measures included success, breakthrough fungal infection, persistent base-line fungal infection, persistent fever, premature discontinuation and death. Patient probability data were extracted from a published clinical trial. Resource consumption and alternative treatment after initial failure with either agent were estimated by an expert panel. Cost was based on most recent available data within Turkey. Deterministic and probabilistic sensitivity analyses were performed to determine the model's robustness.

Results: Compared to LAMB, VORI was the cost-effective alternative per patient treated (TL$2,523 difference in favor of VORI, approx USD$1396) and per patient survival (TL$2,520 difference in favor of VORI, approx USD$1394). LAMB was preferred when considering the cost per successfully treated patient (TL$5,362 difference in favor of LAMB, approx USD$2966). LAMB had a higher likelihood of success (30.57% vs. 26.02%) and lower probability of death than VORI (5.92% vs. 7.95%). Increasing the list cost or length of stay (LOS) of VORI by > 32.4% or 1.2 days, respectively, resulted in VORI no longer being the preferred alternative. Decreasing list cost or LOS for LAMB by >15.8% or 1.0 days, respectively, resulted in LAMB becoming favorable. Monte Carlo simulation (MCS) of 10,000 subjects, with variability imputed upon the published outcome probabilities, LOS and hospitalization costs, resulted in a 64% chance of favoring VORI.

Conclusion: VORI appears to be cost-effective when compared to LAMB in the empiric treatment of FN from the Turkish health care system perspective. One-way sensitivity analyses did not change the conclusion with MCS supporting a 64% chance of favoring VORI. The outcome was highly sensitive to list cost and LOS.

Stuart Turner, MPH, Health Economics and Outcomes Research, Rutgers University, East Hanover, NJ, Esin Senol, MD, Department of Infectious Disease, Gazi University, Ankara, Turkey, Ates Kara, MD, Faculty of Medicine, Dept of Pediatrics, Hacettepe University, Ankara, Turkey, Daoud Al-Badriyeh, PhD, College of Pharmacy, Qatar University, Doha, Qatar, David Kong, PhD, Department of Pharmacy Practice, Monash University, Parkville, Australia and Ener Dinleyici, MD, Department of Pediatric Intensive Care and Infectious Disease Unit, Eskisehir Osmangazi University Faculty of Medicine, Eskisehir, Turkey

Disclosures:

S. Turner, None

E. Senol, Merck: Speaker's Bureau, Speaker honorarium
Gilead Sciences: Speaker's Bureau, Speaker honorarium
Pfizer: Speaker's Bureau, Speaker honorarium
Novartis: Speaker's Bureau, Speaker honorarium

A. Kara, Merck: Speaker's Bureau, Speaker honorarium
Gliead Sciences: Speaker's Bureau, Speaker honorarium
Pfizer: Speaker's Bureau, Speaker honorarium

D. Al-Badriyeh, None

D. Kong, Pfizer: Grant Investigator and Scientific Advisor, Consulting fee and Research grant
Merck: Grant Investigator, Research grant
Novartis: Grant Investigator, Research grant
Gilead Sciences: Grant Investigator, Research grant

E. Dinleyici, Biocodex International: Scientific Advisor, Consulting fee, Grant recipient and Speaker honorarium
GSK: Scientific Advisor, Consulting fee, Grant recipient and Speaker honorarium
Merck: Consultant, Grant recipient
Pfizer: Consultant, Grant recipient
Novartis: Consultant, Grant recipient

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