Prior clinical trials have demonstrated efficacy and effectiveness of
posaconazole in the prophylaxis of invasive
fungal diseases in high-risk patients. Controversy exists about the cost-effectiveness of this approach. We performed an analysis comparing the direct costs of
posaconazole prophylaxis against polyene mouthwash (
thrush) prophylaxis in patients with acute myelogenous leukaemia (AML). Data of AML patients receiving
remission-induction chemotherapy were extracted from the CoCoNut (Cologne Cohort of Neutropenic Patients) database to compare hospital costs of patients before (2003-2005) and after (2006-2008) introduction of
posaconazole prophylaxis. Treatment on general ward, intensive care unit (ICU),
mechanical ventilation, diagnostic procedures, and all anti-infectives were calculated. Patient groups were well matched according to age, gender and duration of
neutropenia. The mean costs per patient in the
posaconazole group (n = 76) and the polyene mouthwash group (n = 81) were €21 040 (95% confidence interval (CI): €18 204-€23 876) and €23 169 (95% CI: €19 402-€26 937) per patient. Antifungal treatment costs were €4580 (95% CI: €3678-€5482) and €4019 (95% CI: €2825-€5214). Duration on the ICU was 2582 (95% CI: 984.1-4181.7) and 5517 (95% CI: 2206-8827.3) min. In our hospital, primary antifungal prophylaxis by
posaconazole was cost-effective. There was a trend towards cost savings, which was primarily caused by a shorter overall
length of stay and the less frequent ICU treatment.