Global Antifungal Pharmacoeconomic Analysis

This analysis compares antifungal treatments (voriconazole, caspofungin, and LAmB) across multiple countries, assessing cost-effectiveness in hematology/oncology patients.

Key Study Findings by Country

(2009) Australia - Voriconazole vs LAmB (CEA): Hematology/oncology patients (AML, chemotherapy/HSCT). LAmB net cost saving AU$1422/patient.

(2009) Australia - Caspofungin vs LAmB (CMA): Caspofungin net cost saving AU$7245/patient.

(2012) Australia - Caspofungin vs voriconazole (CMA): Caspofungin net cost saving AU$798/patient.

(2007) UK - Caspofungin vs LAmB (CUA): Caspofungin saved GBP£2033/patient + 0.40 QALYs.

(2007) USA - Voriconazole vs LAmB (CMA): 27% reduced cost with voriconazole (US$14950 vs US$20591).

(2008) Germany - Caspofungin vs LAmB (CMA): €298 extra cost/patient with LAmB, worse renal outcomes.

(2008) Italy - Caspofungin vs LAmB (CUA): €3470 saved/patient + 0.25 QALYs with caspofungin.

(2007) USA - Caspofungin vs LAmB (CMA): US$5326 less with caspofungin, better renal outcomes.

(2011) Sweden - Caspofungin vs LAmB (CUA): SEK38,080 saved + 0.25 QALYs with caspofungin.

(2008) Spain - Multi-drug comparison (CEA): Voriconazole showed €144,794 net saving vs alternatives.

(2007) USA - Voriconazole vs LAmB (CEA): US$2551 saved/episode with voriconazole.

Conclusion

This multinational analysis demonstrates significant cost variations between antifungal regimens, with consistent savings for newer agents (voriconazole, caspofungin) versus LAmB across healthcare systems.

Pharmacoeconomic Analysis of Antihypertensive Medication Persistence

Study Population and Methodology

An aggregate of 19,995 subjects were taken on the review. Of these, 5933 subjects (29.7% of enrollees) were excluded: 3673 (18.4% of enrollees) because they were taking a class of medication excluded from the review, 1443 (7.2% of enrollees) due to joining several medication classes, 480 (2.4% of enrollees) due to death, and 337 (1.7% of enrollees) because they moved away during the follow-up period.

A total of 14,062 patients were included in the study, 6098 men (43.4%) and 7964 women (56.6%) with a mean age of 56.9±17.7 years (range 20-105 years). ACE inhibitors were the most commonly prescribed medication (28.0%), followed by CCBs (23.8%), diuretics (23.8%), β-blockers (17.6%), and AIIAs (6.9%).

Treatment Persistence Results

Within the population, 60.3% of patients discontinued treatment, 30.9% continued treatment, and 8.8% switched treatment. Among those who discontinued, 83.3% interrupted the treatment after a single prescription. Among the continuers, 81.1% maintained their enrollment treatment throughout the follow-up period without switching. The rates of continuers, switchers, and discontinuers varied significantly among the five medication classes (p<0.001).

Persistence with therapy was related to age (each year of age decreased the risk of discontinuation by 2.2%), coronary heart disease or diabetes (subjects not treated for these showed a higher risk of stopping), hospitalization history for cardiovascular disease, comorbidities, and the antihypertensive class prescribed at enrollment.

Patients starting on AIIAs were more likely to remain on treatment compared to those on ACE inhibitors (38.6% higher discontinuation risk), CCBs (66.3% higher risk), and diuretics (85.3% higher risk). Gender and the use of anti-asthmatic drugs were not significantly associated with treatment persistence.

Cost Analysis Findings

The total cost for the study cohort was €1,238,752.37, of which €745,328.31 was for continuers (60.2%), €253,293.08 for switchers (20.4%), and €240,130.98 for discontinuers (19.4%). The average yearly cost per patient was €88.09 (95% CI, €86.10–€90.08). The cost varied significantly based on the medication class and persistence patterns (p<0.001).

The annual cost of antihypertensive treatment was associated with age (each year reduced the cost by €0.43), persistence patterns (switchers incurred €33.17 higher costs than continuers), and the number of drug classes prescribed (each additional class increased the cost by €10.94).

Patients who began treatment with diuretics had lower annual costs compared to those starting on β-blockers (€67.45 more), ACE inhibitors (€168.20 more), CCBs (€188.84 more), and AIIAs (€278.19 more).