Pharmacoeconomics of voriconazole

Abstract

Voriconazole is a second-generation triazole that is a synthesized derivative of fluconazole. It first appeared in the US market in 2002. Voriconazole is available in oral and intravenous dosage forms, and does have excellent bioavailability. It comes with wide-spectrum antifungal activity, including high effectiveness against a range of fungal organisms, including Candida, Fusarium, Paecilomyces and Scedosporium species, but voriconazole is especially known for its activity against Aspergillus species. Voriconazole is used in practice for three types of management strategies, which are: targeted, empirical and prophylactic. But voriconazole is a high-cost antifungal agent and, hence, its performance should be evaluated against its cost, especially in relation to the costs of other comparable antifungal agents. This chapter aims at summarizing 22 peer-reviewed pharmacoeconomics studies on voriconazole, which were identified in the English literature, up to April 2014. The studies took place in a number of countries, including the USA, Canada, Spain, Switzerland, The Netherlands, Germany, Australia, Belgium and Turkey. All evaluations were retrospective in nature, with the majority suggesting that voriconazole is a cost-effective option against invasive fungal diseases, via the different treatment strategies, as compared to other commonly used antifungal agents, which included conventional amphotericin B, liposomal amphotericin B, caspofungin, posaconazole and fluconazole. Interestingly, half of the identified publications (n=11) were only related to the economic impact of targeted voriconazole against invasive aspergillosis. Economic data to help guide the utilization of voriconazole as prophylaxis or empirical therapy, as well as targeted therapy against invasive candidiasis, remain lacking.