International Journal of Hematology

, Volume 107, Issue 2, pp 235–243 | Cite as

Fluconazole versus mould-active triazoles for primary antifungal prophylaxis in adult patients with acute lymphoblastic leukemia: clinical outcome and cost-effectiveness analysis

Original Article


This study evaluated the clinical and cost-effectiveness of prophylactic use of fluconazole versus mould-active triazoles (voriconazole and posaconazole) in adult patients with acute lymphoblastic leukemia (ALL). A decision analytical model was developed with inputs from a 7-year retrospective study (2009–2016) of 103 consecutive adult patients with ALL who received antifungal prophylaxis. Information on the administration of antifungal agents, clinical outcomes, and costs were collected. One-way sensitivity analyses and probabilistic sensitivity analysis were performed. The mould-active triazoles group was associated with higher life-years (3.71 vs 3.59) and lower total costs (US$4886 vs US$5722) per patient compared with fluconazole. One-way sensitivity analyses revealed that varying all of the key variables in the model did not affect the robustness of the results. Probabilistic sensitivity analysis demonstrated that mould-active triazoles had a probability of 77.1 and 90.1% of providing a dominant and cost-effective option relative to fluconazole, respectively. Mould-active triazoles should be regarded as preferable to fluconazole as the first-line prophylactic for adult patients with ALL accompanied by uncommon severe vinca alkaloid-induced neurotoxicity. However, the results reported here should be interpreted with caution owing to the observational nature of the data.


Cost-effectiveness Antifungal agents Prophylaxis Acute lymphoblastic leukemia 



This work was supported by the National Natural Science Foundation of China (No. 81473177 and 81672954) and the Natural Science Foundation of Shaanxi Province (No. 2016JM8015).

Compliance with ethical standards

Conflict of interest

The authors report no conflicts of interest.


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Copyright information

© The Japanese Society of Hematology 2017

Authors and Affiliations

  • Yan Wang
    • 1
  • Yuanming Xing
    • 2
  • Lu Chen
    • 1
  • Ti Meng
    • 1
  • Ying Li
    • 1
  • Jiao Xie
    • 1
  • Limei Chen
    • 3
  • Yalin Dong
    • 1
  • Weihua Dong
    • 1
  1. 1.Department of PharmacyThe First Affiliated Hospital of Xi’an Jiaotong UniversityXi’anChina
  2. 2.Hou Zonglian Medical Class of 2014Xi’an Jiaotong UniversityXi’anChina
  3. 3.Department of HematologyThe First Affiliated Hospital of Xi’an Jiaotong UniversityXi’anChina

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