[Economic evaluation of voriconazole versus amphotericin B in the treatment of invasive aspergilosis]. / Evaluación económica del uso de voriconazol versus anfotericina B en el tratamiento de la aspergilosis invasiva.

OBJECTIVE: Invasive aspergillosis is an infection with high incidence and mortality. Voriconazole is a new antifungal agent that presents a high efficacy against Aspergillus. The aim of this evaluation was to carry out a pharmacoeconomic analysis of the use of voriconazole versus amphotericin B deoxycholate in the treatment of invasive aspergillosis in Spain. MATERIAL AND METHODS: A cost-effectiveness analysis has been performed by building a decision analytical model. Effectiveness data, probabilities of the different branches of the decision tree and consumption of healthcare resources were obtained from a clinical trial that compared voriconazole versus amphotericin B in the treatment of invasive aspergillosis and from a local expert panel in order to incorporate the model in the daily medical practice in our country. Only direct medical costs were included in the model (drug acquisition, length of hospital stay, analytical tests and treatment of therapeutic failures). The perspective chosen for this analysis was hospital assistance and the time horizon selected was 12 weeks, the maximum time that patients were followed up in the referenced clinical trial. RESULTS: Therapeutic success was reached in 52.8% of patients treated with voriconazole and in 31.6% of the group treated with amphotericin B. The cost of treating a patient with voriconazole or amphotericin B was of 56,296 and 56,382 Euros respectively, while the cost/effectiveness ratio was of 106,621 and 178,424 Euros. The incremental analysis performed shows how the use of voriconazole versus amphotericin B produces a healthcare resources saving of 406 Euros per patient. CONCLUSIONS: Voriconazole is more efficient than amphotericin B deoxycholate in the treatment of invasive aspergillosis, (thus) resulting in healthcare resources saving due to better clinical results with lower associated costs.

Evaluación económica del uso de voriconazol versus anfotericina B en el tratamiento de la aspergilosis invasiva / Economic evaluation of voriconazole versus amphotericin B in the treatment of invasive aspergilosis

Introducción: La aspergilosis invasiva es una infección con una incidencia creciente y una elevada mortalidad asociada. Voriconazoles un antifúngico que ha demostrado una alta eficacia en el tratamiento de esta enfermedad. El objetivo de este estudio ha sido efectuar un análisis farmacoeconómico del uso de voriconazol versus anfotericina B deoxicolato, en el tratamiento de la aspergilosis invasiva en nuestro país. Material y métodos: Se ha elaborado un análisis coste-efectividad empleando un modelo farmacoeconómico elaborado a través de un análisis de decisión. Los datos de efectividad, las probabilidades del árbol de decisión y el consumo de recursos, fueron obtenidos de un ensayo clínico que comparó ambas alternativas terapéuticas y de un panel de expertos local, con el fin de incorporar el modelo a la práctica médica habitual de nuestro medio. Solamente se han incluido en este análisis los costes médicos directos (coste de la medicación, días de hospitalización, analíticas y tratamiento del fallo terapéutico).La perspectiva elegida para el análisis ha sido el hospital, y el horizonte temporal escogido ha sido de 12 semanas, tiempo máximo que los pacientes fueron seguidos en el ensayo clínico de referencia. Resultados: En el estudio de referencia, los pacientes tratados con voriconazol presentaron éxito terapéutico en el 52,8 frente al31,6% en el grupo tratado con anfotericina B deoxicolato. El coste de tratar un paciente con voriconazol o con anfotericina B deoxicolato, fue de 56.296 y 56.382 € respectivamente, mientras que el cociente coste/efectividad medio fue de 106.621 y 178.424 €, al emplear ambas opciones en evaluación. El análisis coste-efectividad incremental efectuado muestra queel uso de voriconazol versus el de anfotericina B deoxicolato,supone un ahorro de recursos sanitarios de 406 € por paciente. Conclusiones: Voriconazol es una opción más eficiente que la anfotericina B deoxicolato en el tratamiento de la aspergilosis invasiva, lo que se traduce en un ahorro de recursos, derivado de producir mejores resultados clínicos con costes asociados más bajos

Objective: Invasive aspergillosis is an infection with high incidence and mortality. Voriconazole is a new antifungal agent that presents a high efficacy against Aspergillus. The aim of this evaluation was to carry out a pharmacoeconomic analysis of the use of voriconazole versus amphotericin B deoxycholate in the treatment of invasive aspergillosis in Spain. Material and methods: A cost-effectiveness analysis has been performed by building a decision analytical model. Effectiveness data, probabilities of the different branches of the decision tree and consumption of healthcare resources were obtained from a clinical trial that compared voriconazole versus amphotericin B in the treatment of invasive aspergillosis and from a local expert panel in order to incorporate the model in the daily medical practice in our country. Only direct medical costs were included in the model (drug acquisition, length of hospital stay, analytical tests and treatmentof therapeutic failures).The perspective chosen for this analysis was hospital assistance and the time horizon selected was 12 weeks, the maximum time that patients were followed up in the referenced clinical trial. Results: Therapeutic success was reached in 52.8% of patients treated with voriconazole and in 31.6% of the group treated with amphotericin B. The cost of treating a patient with voriconazole or amphotericinB was of 56,296 and 56,382 € respectively, while the cost/effectiveness ratio was of 106,621 and 178,424 €.The incremental analysis performed shows how the use of voriconazole versus amphotericin B produces a healthcare resources saving of 406 € per patient. Conclusions: Voriconazole is more efficient than amphotericin B deoxycholate in the treatment of invasive aspergillosis, (thus)resulting in healthcare resources saving due to better clinical results with lower associated costs

[Impact of zidovudine treatment and the pneumocystis carinii prophylaxis in natural history of patients with HIV infection]. / Influencia del tratamiento con zidovudina y de la profilaxis contra Pneumocystis carinii en la historia natural de los enfermos con infección por VIH.

INTRODUCTION: Early use of prophylactic regimens against Pneumocystis carinii and zidovudine therapy, may have modified the natural history of patients with HIV-1 infection. We describe the incidence of opportunistic infections and analize the mortality rate in those patients to check the occurrence of any change in the above mentioned natural history. PATIENTS: Clinical charts of patients with HIV-1 infection attending our hospital are reviewed, from november 1987 to june 1994. RESULTS: We found 200 patients with AIDS, documenting 64 (32%) deaths and 69 (34.5%) patients lost to follow-up. Seven HIV-1 infected patients (3.5%) received primary prophylaxis against Pneumocystis carinii and 17 (8.5%) zidovudine therapy before developing AIDS. Patients with AIDS receiving zidovudine therapy had a higher survival (median 50 months) than those not receiving such therapy (median 17 months; p < 0.001). Ninety one patients with tuberculosis receiving zidovudine therapy had also a higher survival than those not receiving antirretroviral therapy (p < 0.01). Eighty six patients with Pneumocystis carinii pneumonia receiving zidovudine had also a higher survival (p < 0.001). Likewise, patients on zidovudine treatment had a lower reduction on CD4 lymphocyte count. CONCLUSIONS: The spectrum of AIDS-defining illnesses is similar to the whole country. We have not found any difference in the incidence of opportunistic infections, but we observed a trend to reduction in the incidence rate of PCP. The introduction of zidovudine therapy seems to have a positive influence on the survival of AIDS patients. This advantage is highlighted in those patients more immunodeficients at first.