Pharmacoeconomics of voriconazole in the management of invasive fungal infections.

The incidence of invasive fungal infection has risen in recent years with the introduction of more intensive chemotherapy regimens and the advent of stem cell and solid-organ transplants. In patients undergoing chemotherapy, mortality rates ranging from 50 to 90% have been associated with documented invasive fungal infection. Voriconazole is a second-generation triazole, which is a synthesized derivative of fluconazole. It was first approved for marketing in the USA in 2002. Voriconazole has excellent bioavailability and is available in oral and intravenous dosage form. It has extended-spectrum antifungal activity whereby it is highly effective against a variety of fungal organisms, including Candida, Fusarium, Paecilomyces and Scedosporium species, but it is especially known for its activity against the Aspergillu s species. Voriconazole has become widely used for three types of treatment strategies (i.e., targeted, empirical and prophylactic). However, voriconazole is a high-cost antifungal agent and, therefore, its effectiveness should be scrutinized, taking into consideration its cost in relation to the costs of other comparable antifungal agents. This article summarizes the 18 identified peer-reviewed publications on the pharmacoeconomics of voriconazole in the English literature, up to March 2010, and provides a view on its future role in therapy. Comparisons with existing antifungals are provided when possible to illustrate the potential role of voriconazole in a clinical setting. The studies took place in a variety of countries and were all retrospective in nature, with the majority suggesting that voriconazole is a more cost-effective option for antifungal treatment. Of the 18 evaluations, 11 were related to the economic impact of voriconazole against invasive aspergillosis only. Economic data to guide the use of voriconazole as prophylaxis or empirical therapy as well as targeted therapy against invasive candidiasis remain limited.