OBJECTIVES: In immunocompromised patients, presumed systemic fungal infections (SFI) are treated empirically with an intravenous (IV) antifungal to reduce the occurrence of documented infections and associated mortality. Amphotericin B (AB) remains the treatment of choice. The toxicity of conventional AB (CAB) often results in discontinuation or suboptimal dosing. Liposomal or lipid formulations of AB (LAB), with improved toxicity profile, are extremely expensive. The objective was to compare the cost-effectiveness of intravenous itraconazole (IVitra) with CAB and LAB as empirical treatment of presumed SFI in neutropenic cancer and bone marrow transplant (BMT) patients. METHODS: A medical decision tree was developed, including probabilities of toxicity, response, pathogen documentation and 2nd line treatments. Clinical data were obtained from randomized trials comparing IVitra with CAB (n=392) and CAB with LAB (n=687). Resource use was obtained via modified Delphi consensus panel, unit costs from official sources (public payer perspective). Cost-effectiveness was expressed as cost per additional “responder” (defined as patient without fever or major toxicity). RESULTS: The total cost per neutropenic cancer patient was lowest for IVitra (7,486€), followed by CAB (9,721€) and LAB (11,956€). The same cost ranking was obtained in BMT patients, however with higher hospitalization costs. The variables accounting for cost differences between strategies were 1st and 2nd line antifungal drug costs. In cost-effectiveness analysis, IVitra was dominant over CAB combining greater ‘effectiveness’ (because of less toxicity) and lower costs. The incremental cost-effectiveness ratios for LAB over IVitra in neutropenic cancer and BMT patients were 188,638€/”responder” and 206,865 €/”responder” respectively . CONCLUSIONS: IVitra was shown to be a cost-effective empirical treatment for presumed SFI in neutropenic cancer and BMT patients and to be cost saving compared to both CAB and LAB. These conclusions are similar to those for UK, Germany, Italy and Sweden, in which the same analysis was performed earlier.