THE COST OF TREATING MUCORMYCOSIS WITH ISAVUCONAZOLE COMPARED WITH LIPOSOMAL AMPHOTERICIN B FOLLOWED BY POSACONAZOLE IN THE UNITED KINGDOM- ECONOMIC EVALUATION OF THE PHASE III VITAL STUDY AND FUNGISCOPE MATCHED CASE-CONTROL ANALYSIS

Author(s)

Kuessner D1, Bagshaw E2, Blackney M2, Cornely OA3, Heimann SM3, Posthumus J1
1Basilea Pharmaceutica International Ltd., Basel, Switzerland, 2Covance Market Access, London, UK, 3University Hospital of Cologne, Cologne, Germany

OBJECTIVES:  Mucormycosis is a rapidly progressive fungal infection, associated with high mortality, particularly when appropriate treatment is not promptly initiated. Until recently, the only licensed treatments were amphotericin B (AMB) formulations, which have considerable limitations. AMB deoxycholate is nephrotoxic, while the less nephrotoxic liposomal AMB (L-AMB) – standard treatment in the United Kingdom (UK) – is costly. Isavuconazole (ISAV) is a new intravenous and oral triazole antifungal for the treatment of mucormycosis in adults for whom AMB is inappropriate. A cost-minimisation model was developed to explore the cost of treating mucormycosis with ISAV versus L-AMB followed by maintenance treatment with off-label, oral posaconazole (POSA) in the UK. METHODS:  The cost-minimisation analysis estimated per-patient treatment costs for mucormycosis from the UK National Health Service perspective. The time horizon was until end of treatment. A matched case-control analysis of the phase III, single-arm VITAL study of ISAV in mucormycosis and the FungiScope™ registry showed similar efficacy of ISAV and AMB (mainly L-AMB) ± POSA. Treatment-related costs comprised on-treatment drug acquisition, monitoring and administration costs, and hospitalisation costs. Clinical inputs, including treatment durations and dosing regimens, were derived from the VITAL study and FungiScope™ analysis. Monitoring requirements were based on adverse events and precautions reported in Summary of Product Characteristics documentation. Unit costs were from publicly available UK sources. RESULTS:  The estimated per-patient cost of treating mucormycosis with ISAV and L-AMB + POSA was £26,810 and £41,855, respectively. Savings were primarily driven by reduced drug acquisition costs with ISAV relative to L-AMB + POSA, alongside lower hospitalisation costs since ISAV patients could be switched from IV to oral treatment earlier than LAMB + POSA patients. CONCLUSIONS:  Based on the matched case-control comparison between patients receiving treatment with ISAV or L-AMB, ISAV is expected to reduce costs by 36% compared with standard mucormycosis treatment in the UK. 

Conference/Value in Health Info

2016-10, ISPOR Europe 2016, Vienna, Austria

Value in Health, Vol. 19, No. 7 (November 2016)

Code

PIN57

Topic

Economic Evaluation

Topic Subcategory

Cost-comparison, Effectiveness, Utility, Benefit Analysis

Disease

Infectious Disease (non-vaccine), Rare and Orphan Diseases

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