Zhao, Y.J., Khoo, A.L., Tan, G., Teng, M., Tee, C., Tan, B.H., . . . Chai, L.Y. (2016). Network meta-analysis and pharmacoeconomic evaluation of fluconazole, itraconazole, posaconazole, and voriconazole in invasive fungal infection prophylaxis. Antimicrobial Agents and Chemotherapy, 60, 376–386.
STUDY PURPOSE: To examine the efficacy and cost-effectiveness of various azoles for antifungal prophylaxis in patients with hematologic malignancies undergoing chemotherapy or cell transplantation
TYPE OF STUDY: Meta-analysis and systematic review
PHASE OF CARE: Active antitumor treatment
Overall, proven or probable fungal infection occurred in 5% of the study population—45% were Candida and 49% were Aspergillus. All triazoles were better than placebo, except for itraconazole. Various triazoles differed in terms of tolerability and specific treatment-related side effects. Comparative efficacy analysis was in favor of posaconazole based on numerous outcomes evaluated. Itraconazole was associated with more study withdrawals but was also the least costly. Incremental cost-effectiveness ratios (ICER) were calculated for each agent. This analysis showed that posaconazole had a higher ICER than comparators. All triazoles except for intraconazole capsules were found to be effective in reducing fungal infection.
The findings suggest that posaconazole may more cost-effective for antifungal prophylaxis than the other triazoles examined. Itraconazole capsules were not shown to be effective.
The findings showed that all azoles other than itraconzole capsules were effective for antifungal prophylaxis, and that posaconazole may be the most cost-effective agent.