Cost-Effectiveness Analysis of Isavuconazole vs. Liposomal Amphotericin B for the Treatment of Invasive Mucormycosis in Morocco
Author(s)
Amr Maoujoudi, MD PhD1, Maha Soussi Abdellaoui, MD2, Rihab Al-Homsi, Pharm.D3, Nimer Alkhatib, PhD4, Ahmad Aburmilah, M.Sc3, Bouchra Essaoui, B.Pharm5, Jalal Kamel Atieh, BSc Pharm3.
1Faculty of medicine Mohammed V University rabat Morocco, Rabat, Morocco, 2CHU Ibn Rochd, Hassan II University of Casablanca, Casablanca, Morocco, 3Hikma Pharmaceuticals, Amman, Jordan, 4Path Economics, Amman, Jordan, 5Hikma Pharmaceuticals, Casablanca, Morocco.
1Faculty of medicine Mohammed V University rabat Morocco, Rabat, Morocco, 2CHU Ibn Rochd, Hassan II University of Casablanca, Casablanca, Morocco, 3Hikma Pharmaceuticals, Amman, Jordan, 4Path Economics, Amman, Jordan, 5Hikma Pharmaceuticals, Casablanca, Morocco.
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 in Morocco, from Moroccan healthcare 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 (149 days of intravenous therapy). 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 Moroccan 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 21,788.40 USD for isavuconazole and 122,614.88 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 -138,843.92 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 Morocco. These findings support its use in clinical practice and may support clinicians in optimizing therapeutic decisions.
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 (149 days of intravenous therapy). 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 Moroccan 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 21,788.40 USD for isavuconazole and 122,614.88 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 -138,843.92 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 Morocco. These findings support its use in clinical practice and may support clinicians in optimizing therapeutic decisions.
Conference/Value in Health Info
2025-11, ISPOR Europe 2025, Glasgow, Scotland
Value in Health, Volume 28, Issue S2
Code
EE209
Topic
Economic Evaluation
Disease
Infectious Disease (non-vaccine)