OBJECTIVES: Patients with haematologic malignancies are at high risk of breakthrough invasive fungal infections (bIFIs), which are associated with high morbidity and mortality. Anti-mould prophylaxis and treatments have been introduced which have improved patient outcomes. This analysis estimates the budget impact of posacoanzole and fluconaozole, two prophylactic agents that prevent bIFIs in patients with acute myeloid leukaemia (AML) and myelodysplastic syndromes (MDS).

METHODS: We developed a budget impact model looking at the costs of a hypothetical cohort of 100 patients in a posaconazole primary prophylaxis pathway versus a fluconazole primary prophylaxis pathway. The key cost and efficiency drivers considered are: drug acquisition, diagnostic test, antibiotic and hospitalisation costs associated with a bIFI. Key data on the costs of an infection come from a peer-reviewed published observational study in the UK. Differences in bIFI rates between posaconazole and fluconazole were demonstrated in multi-centre Phase 3 randomised controlled trials.

RESULTS: For 100 patients, posaconazole has higher drug acquisition costs versus fluconaozole (£216,398 versus £4,832 for a 28-day course). However, posaconazole is associated with less subsequent antifungal costs (£11,507 vs £46,026), and non-antifungal drug costs (£68,000 versus £272,000 in AML) and (£126,514 versus £506,056 in MDS). Send home antifungal costs were £97 in the posaconazole pathway versus £17,312 in the fluconaozole pathway. Overall, the indicative total costs for posaconazole is (£296,001) versus fluconaozole (£340,170) in AML, which increases to £354,515 for the posaconazole pathway versus £574,226 for the fluconaozole pathway in patients with MDS.

CONCLUSIONS: Looking across the continuum of care, posaconzaole is associated with lower overall costs versus fluconaozole. It is important to note that switching drugs will incur initial reductions in drug expenditure; however it has the potential to increase the overall NHS activity and therefore cost. The impact on patient outcomes, financial stewardship and operational efficiency is aligned to the principles of medicines optimisation.