OBJECTIVES: To examine the cost-effectiveness of isavuconazole versus voriconazole for the treatment of invasive aspergillosis (IA) in Jordan.

METHODS: We conducted a cost-utility analysis comparing isavuconazole and voriconazole for the treatment of IA using a decision tree model. Patients with possible IA entered the model, with 6% assumed to actually have invasive mucormycosis (IM). The Jordanian Food and Drug Administration was contacted for information regarding the cost of medications. The costs of hospitalization were estimated from four main private hospitals in Amman, Jordan. Cost of medications administration, treatment switches, oral step-down therapy, nephrotoxicity and lab tests monitoring were included in the model. Our model incorporates data and clinical definitions from published randomized clinical trials, observational studies, medical guidelines, and clinical practice. A one-way sensitivity analysis was performed to assess the reliability of the results. Our model was constructed from the payer's perspective.

RESULTS: The total cost of isavuconazole for the treatment of IA was 12,252.5 Jordanian Dinar (JOD) (1 JOD: 1.41 USD), and 2,967.8 JOD for patients with IM. The total cost of voriconazole for the treatment of IA and IM was 9,980.3 JOD and 5,463.0, respectively. We assumed that 20% of patients remain on voriconazole despite having IM. The combined estimated quality-adjusted life year (QALY) associated with isavuconazole treatment and voriconazole treatment for IA and IM was 6.81 QALY and 5.91 QALY, respectively. The incremental cost-effectiveness ratio (ICER) for the use of isavuconazole versus voriconazole for the treatment of IA was -248.68 JOD per QALY gained. Our model was sensitive to the probability of switching voriconazole to liposomal amphotericin in the case of IM and the survival rates of isavuconazole and voriconazole in IA.

CONCLUSIONS: From the payer's perspective in Jordan, isavuconazole is a cost-effective treatment option for IA. Our findings can help clinicians prescribe cost-effective medications for patients with IA.