The Economic Impact of Managing Invasive Aspergillosis in Brazilian Private Healthcare: A Comparative Analysis Between Isavuconazole and Voriconazole

Proper management of invasive aspergillosis must balance clinical efficacy and financial sustainability across the following main components: antifungal drugs, adverse events, and hospitalizations. This study aimed to compare the economic impact of isavuconazole versus voriconazole for the treatment of invasive aspergillosis from the perspective of Brazilian private healthcare. Three comparative scenarios were defined over a 42-day time horizon, according to the route of administration of the drugs studied: (1) intravenous; (2) intravenous with switch to oral; (3) oral. Treatment costs were calculated based on the CMED price list. An average body weight of 60 kilograms was adopted to calculate weight-dependent costs. A micro-costing approach was used to estimate the costs of adverse events and hospital daily rates from the Brazilian private healthcare perspective. Published literature was used to assign costs of adverse events and hospitalization for each drug 1, 2. Total cost was calculated as the sum of treatment cost, adverse events, and hospitalization. Isavuconazole had lower costs for adverse events (R 5, 685. 87) and hospitalization (R 11, 954. 12) compared with voriconazole (R 7, 472. 13 and R 23, 908. 23, respectively). Comparative scenarios—treatment cost and total cost: (1) Intravenous administration: Isavuconazole: R 88, 059. 64; total: R 105, 699. 62. Voriconazole: R 118, 193. 52; total: R 149, 573. 88. (2) Intravenous with switch to oral: Isavuconazole: R 40, 315. 18; total: R 57, 955. 17. Voriconazole: R 45, 788. 43; total: R 77, 168. 79. (3) Oral administration: Isavuconazole: R 33, 153. 51; total: R 50, 793. 50. Voriconazole: R 47, 122. 84; total: R 78, 503. 20. Isavuconazole showed total cost reductions of 41. 5%, 33. 2%, and 54. 6% compared with voriconazole in the intravenous, intravenous with switch to oral, and oral administration scenarios, respectively. Based on these results, isavuconazole represents a more economically advantageous alternative for invasive aspergillosis management in Brazilian private healthcare by providing lower treatment costs, adverse event costs, and hospitalization costs compared with voriconazole.