Comparison of Posaconazole Versus Voriconazole in the Induction of Acute Myeloid Leukemia: Impact on Cost, Safety, and Efficacy

Background: University Health Shreveport has switched from using posaconazole to voriconazole for the prevention of invasive fungal infections in patients with acute myeloid leukemia (AML) undergoing intensive chemotherapy in February 2016. There are no current studies comparing the cost effectiveness of posaconazole tablets to voriconazole in reducing invasive fungal infection in this patient population. Therefore, the purpose of this study is to compare the cost of posaconazole to voriconazole in patients with AML undergoing intensive chemotherapy, in addition to the incidence of adverse effects and reduction of invasive fungal infections. Methods: Single-center, quality improvement study utilizing retrospective chart review of 20 patients with AML receiving voriconazole (n = 10) or posaconazole (n = 10) for prevention of invasive fungal infections. Results: Twenty patients with AML undergoing intensive chemotherapy received voriconazole (n = 10) or posaconazole (n = 10). Baseline characteristics were similar between groups. The average cost per patient for posaconazole was $4,032.20 (acquisition cost of posaconazole 100 mg tablet $55.54) compared to $1,209.52 for voriconazole (acquisition cost of 200 mg tablet $24.99). In reference to adverse effect profiles, 50% of patients in the posaconazole group switched to an alternative antifungal agent. Of those, 80% switched due to increased liver function tests. In the voriconazole group, 40% of patients switched to an alternative agent, and of those, 75% were due to increased liver function tests. In both groups, no patients experienced an invasive fungal infection.Tabled 1ResultPosaconazole (n = 10)Voriconazole (n = 10)Baseline Characteristics56Male (n)54Female (n)61.5 years [39, 68]63 years [24, 77]Median age [range]7/10 = 70%9/10 = 90%Chemotherapy regimen1/10 = 10%0 Idarubicin + cytarabine1/10 = 10%1/10 = 10% Daunorubicin + cytarabine1/10 = 10%0 MEC30.9 days29.7 days FLAG-IDAAverage Length of StayCost300 mg = $166.62200 mg = $24.99Average cost per patient$4,032.20$1,209.52Average length of stay30.9 days29.7 daysTotal cost$124,595.10$35,922.63Side Effect Profile5/10 = 50%4/10 = 40%Patients switched (%)4/5 = 80%3/4 = 75% Increase in LFTs1/5 = 20%1/4 = 25% Increase in SCrEfficacy00Invasive fungal infection (%) Open table in a new tab Conclusion: The use of voriconazole in patients with AML undergoing intensive induction chemotherapy resulted in lower system costs compared to the use of posaconazole. Additionally, adverse effect profiles were similar in both groups and no patients experienced an invasive fungal infection.