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Economic Evaluation of Voriconazole versus Caspofungin for the Treatment of Invasive Aspergillosis in Spain Alfonso Domínguez-Gil; 1 Isabel Martín; 2 Mercedes García Vargas; 3 Almudena Del Castillo; 4 Silvia Díaz 3 ; Cristina Sánchez 4 Clin Drug Invest. 2007;27(3):197-205. ©2007 Adis Data Information BV Posted 03/19/2007 Abstract and Introduction Abstract Background and objective: Invasive fungal infections are becoming increasingly prevalent and are more frequently the aetiological agents responsible for nosocomial infections. Since mid-2002, two new antifungal drugs – voriconazole, a third-generation azole, and caspofungin, a member of a new class of drugs called echinocandins – have been marketed in Spain. Both drugs have greater efficacy (because of their specific mechanisms of action), more favourable toxicity profiles and are much less costly than liposomal amphotericin B. The objective of this study was to conduct an economic evaluation of voriconazole versus caspofungin for the treatment of invasive aspergillosis in Spain. Methods: This was a cost-minimisation analysis (2006 costs) from the hospital perspective. Duration of treatment and bodyweight of patients were obtained from the Fungcost study and the incidence of adverse events was obtained from different published sources. Only direct costs were considered. Mean expected cost and incremental cost were calculated, and univariate and bivariate (bodyweight/treatment duration) sensitivity analyses were conducted. Results: The mean expected cost per episode was €6041.93 (intravenous treatment acquisition cost €5524.75) for voriconazole and €7174.05 (intravenous treatment acquisition cost €6672.80) for caspofungin in invasive aspergillosis; the incremental cost was €1132.18. Results were robust for any treatment duration and sensitive to bodyweights <103.42kg. Conclusion: Voriconazole is a more cost-effective option than caspofungin in invasive aspergillosis in patients with a bodyweight <103.42kg. Introduction Invasive fungal infections are becoming increasingly prevalent and are more frequently the aetiological agents responsible for nosocomial infec-tions. [1] Despite therapeutic and diagnostic advances in recent years, invasive fungal infections are still associated with unacceptable morbidity and mortality rates and we are still far from being in a similar situation to that pertaining to management of bacterial diseases. [2] The predominant fungal pathogens are Candida spp. and Aspergillus spp. Although the prevalence of Aspergillus spp. is much lower than that of Candida spp., Aspergillus has a mortality rate as high as 85% in many studies, [3-6] and up to 90% in the case of bone marrow transplant patients. [7] Invasive aspergillosis occurs almost exclusively in immunocompromised patients (AIDS, cancer, diabetes, transplant, surgical, major trauma and burn patients). Intensification of chemotherapy and the increasing number of transplants, as well as the emergence of new immunosuppressant drugs, is leading to the appearance of these infections in patients in whom they were previously uncommon (e.g. leukaemia and
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lymphoma patients).
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