Effectiveness and Cost-Effectiveness of Prophylactic Voriconazole and Fluconazole Regarding Prevention of Post-hematopoi
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ORIGINAL ARTICLE
Effectiveness and Cost-Effectiveness of Prophylactic Voriconazole and Fluconazole Regarding Prevention of Post-hematopoietic Stem Cell Transplantation Invasive Fungal Infection and Its Related Death: A Single Center Experience Amro Mohamed Sedky El-Ghammaz1 • Maha El-Zimaity1 • Amal Mostafa Elafifi1 Essam Abdelwahed1 • Mohamed Mahmoud Moussa1 • Yasmin Ahmed Aboelmagd1 • Mohamed Gamal Kotob1 • Hebatullah Magdy Fares1
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Received: 11 November 2019 / Accepted: 28 January 2020 Indian Society of Hematology and Blood Transfusion 2020
Abstract Purpose Analyzing effectiveness and cost-effectiveness of voriconazole versus fluconazole prophylaxis in hematopoietic stem cell transplantation (HSCT). Methods The research included 70 patients; 34 undergoing allogeneic HSCT and 36 undergoing autologous stem cell transplantation (ASCT), alternated to receive either voriconazole or fluconazole prophylaxis for 180 days on a 1:1 basis. Patients were monitored for occurrence of invasive fungal infections (IFI), IFI-related death (IRD)
Electronic supplementary material The online version of this article (https://doi.org/10.1007/s12288-020-01259-y) contains supplementary material, which is available to authorized users. & Amro Mohamed Sedky El-Ghammaz [email protected] Maha El-Zimaity [email protected] Amal Mostafa Elafifi [email protected] Essam Abdelwahed [email protected] Mohamed Mahmoud Moussa [email protected] Yasmin Ahmed Aboelmagd [email protected] Mohamed Gamal Kotob [email protected] Hebatullah Magdy Fares [email protected] 1
Clinical Hematology and Bone Marrow Transplantation Unit, Department of Internal Medicine, Faculty of Medicine, Ain Shams University, Cairo, Egypt
and total death events. Cost-effectiveness of both agents in both groups was also assessed. Results Antifungal prophylactic drug had no impact on incidence of IFI and IRD in both allogeneic HSCT and ASCT (P = .452 and P = 1.000; P = .457 and P = .146 respectively). An insignificant difference occurred among patients receiving voriconazole or fluconazole regarding overall survival (OS) and fungal infection-free survival (FFS) in both groups (P = .705 and P = .879; P = .713 and P = .681 respectively). Regarding cost-effectiveness, voriconazole dominated fluconazole regarding prevention of IFI and IRD but was less costly/less effective regarding prevention of total death events and gaining life years in the allogeneic HSCT setting. In the ASCT setting, voriconazole was not cost-effective regarding avoidance of IFI and IRD and was dominated by fluconazole regarding avoidance of total death events and gaining life years. Conclusions Voriconazole does not differ from fluconazole regarding its efficacy in prevention of IFI and IRD and does not improve OS and FFS in both allogeneic HSCT and ASCT settings. Voriconazole is cost-effective regarding protection from IFI and IRD in allogeneic HSCT but not cost-effective in ASCT. Keywords Hematopoietic stem cell transplantation Antifungal prophylaxis In
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