OBJECTIVES:: Posaconazole is effective as primary prophylaxis of invasive fungal infections (IFIs) in patients with acute myeloid leukemia (AML). A cost-effectiveness analysis of posaconazole versus standard azole therapy (SAT) has not been conducted in Colombia. This study evaluates the cost-effectiveness of posaconazole (standard azole therapy in Colombia) compared to fluconazole for IFI prevention in AML patients with chemotherapy-induced prolonged neutropenia in Colombia.

METHODS:: We adapted a decision-analytic model based on phase III clinical trial data (probabilities of IFI, IFI-related death, and other death within 100 days) to Colombia, to assess the cost-effectiveness of posaconazole versus Fluconazol (FLU) in the prevention of IFIs among patients with acute myeloi leukemia (AML) from the third payer perspective. We obtained IFI-related costs within 100 days and healthcare resource utilization from an expert committee via a modified Delphi method. Retrospectively we reviewed resource utilization related to AML, antifungal prophylaxis, and IFI for AML patients receiving primary antifungal prophylaxis in a Colombian hospital. Unit costs were captured from hospital and pharmacy pricelists (Colombian pesos; COP) at December 2016 values from a third-party payer perspective. The model predicts IFIs avoided, life-years saved (LYS), total costs, and incremental cost-effectiveness ratio (ICER; incremental cost per IFI avoided/per QALY) RESULTS:: Posaconazole was associate with fewer cases of IFI (0.041 vs 0.11; p=0.003) and increased life years (2.75 vs 2.54). Estimated mean prophylaxis costs per patient were COP$5.558597 (1,821 USD) with posaconazole and COP$659.091 (216 USD) with fluconazole. Over a lifetime horizon, posaconazole prophylaxis resulted in 0.2146 discounted LYS. The resulting incremental cost is COP$19,976,639 (6.543 USD) per QALY that is below of 3 gross domestic product (GDP), currently accepted in Colombia.

CONCLUSIONS:: Posaconazole is cost-effective compared with SAT when used as antifungal primary prophylaxis in AML patients with chemotherapy-induced prolonged neutropenia in Colombia.