Comparative Cost-Effectiveness Analysis of Isavuconazole vs. Liposomal Amphotericin B for the Treatment of Invasive Mucormycosis in Algerian Hospital Setting
Author(s)
Nassima Achour, MD1, Mourad OUALI, MD2, Rihab Al-Homsi, Pharm.D3, YACINE HAMMAS, Pharm.D4, Nimer Alkhatib, PhD5, Ahmad Aburmilah, M.Sc3.
1Infectious Diseases Department at El Hadi FLICI Hospital, Algiers, Algeria, 2Medical ICU at Mustapha BACHA Hospital, Algiers, Algeria, 3Hikma Pharmaceuticals, Amman, Jordan, 4Hikma Pharmaceuticals, Algiers, Algeria, 5Path Economics, Amman, Jordan.
1Infectious Diseases Department at El Hadi FLICI Hospital, Algiers, Algeria, 2Medical ICU at Mustapha BACHA Hospital, Algiers, Algeria, 3Hikma Pharmaceuticals, Amman, Jordan, 4Hikma Pharmaceuticals, Algiers, Algeria, 5Path Economics, Amman, Jordan.
OBJECTIVES: Mucormycosis is a serious opportunistic fungal infection affecting immunocompromised patients, often associated with high mortality and limited treatment options. Amphotericin B-based regimens, typically combined with surgical debridement, remain the most frequently used approach but carry a significant risk of nephrotoxicity. Isavuconazole has emerged as an alternative option for the primary treatment of mucormycosis, offering comparable efficacy to standard of care with better tolerability.This study aims to evaluate the cost-effectiveness of isavuconazole compared to liposomal amphotericin B for the treatment of mucormycosis from Algerian hospital payer perspective.
METHODS: A cost-utility analysis was conducted using a decision tree model comparing isavuconazole (15 days of intravenous therapy followed by 134 days of oral therapy) to liposomal amphotericin B (27 days of intravenous therapy followed by oral posaconazole for 122 days). Direct medical costs were only considered including the cost of drug acquisition, intravenous administration, laboratory monitoring, and hospitalization. Data and clinical definitions were sourced from VITAL study, and all cost inputs were adapted to reflect Algerian healthcare context. Both deterministic (DSA) and probabilistic sensitivity analyses (PSA) were performed to test the robustness of model assumptions and parameter uncertainties. Results were extrapolated to the lifetime horizon of patients with hematological malignancy.
RESULTS: The total treatment cost was estimated to be 16,941.70 USD for isavuconazole and 22,929.01 USD for liposomal amphotericin B. The corresponding quality-adjusted life years (QALYs) gained were 5.91 and 5.18, respectively. The incremental cost-effectiveness ratio (ICER) for isavuconazole versus liposomal amphotericin B was -8,244.86 USD per QALY gained, indicating a dominant strategy. Model sensitivity was highest to the price of liposomal Amphotericin vial and survival rates in mucormycosis. PSA confirmed Isavuconazole as 100% cost-effective at zero willingness-to-pay.
CONCLUSIONS: Isavuconazole is a dominant treatment option for Mucormycosis in Algerian hospital setting. These findings may support its introduction strategy to Algerian market.
METHODS: A cost-utility analysis was conducted using a decision tree model comparing isavuconazole (15 days of intravenous therapy followed by 134 days of oral therapy) to liposomal amphotericin B (27 days of intravenous therapy followed by oral posaconazole for 122 days). Direct medical costs were only considered including the cost of drug acquisition, intravenous administration, laboratory monitoring, and hospitalization. Data and clinical definitions were sourced from VITAL study, and all cost inputs were adapted to reflect Algerian healthcare context. Both deterministic (DSA) and probabilistic sensitivity analyses (PSA) were performed to test the robustness of model assumptions and parameter uncertainties. Results were extrapolated to the lifetime horizon of patients with hematological malignancy.
RESULTS: The total treatment cost was estimated to be 16,941.70 USD for isavuconazole and 22,929.01 USD for liposomal amphotericin B. The corresponding quality-adjusted life years (QALYs) gained were 5.91 and 5.18, respectively. The incremental cost-effectiveness ratio (ICER) for isavuconazole versus liposomal amphotericin B was -8,244.86 USD per QALY gained, indicating a dominant strategy. Model sensitivity was highest to the price of liposomal Amphotericin vial and survival rates in mucormycosis. PSA confirmed Isavuconazole as 100% cost-effective at zero willingness-to-pay.
CONCLUSIONS: Isavuconazole is a dominant treatment option for Mucormycosis in Algerian hospital setting. These findings may support its introduction strategy to Algerian market.
Conference/Value in Health Info
2025-11, ISPOR Europe 2025, Glasgow, Scotland
Value in Health, Volume 28, Issue S2
Code
EE138
Topic
Economic Evaluation
Disease
Infectious Disease (non-vaccine)