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Posaconazole tablets: Predicted vs actual analysis

Page last updated: 26 October 2018

Drug utilisation sub-committee (DUSC)

May 2018

Abstract

Purpose

To compare the predicted and actual use of posaconazole for the treatment and prophylaxis of fungal infections since the tablet form listed on the Pharmaceutical Benefits Scheme (PBS) in September 2015.

PBS Listing (abridged)

Posaconazole is listed on the PBS for the:

  • treatment of invasive aspergillosis and other specified fungal infections in patients who are unable to tolerate, or have disease refractory to, alternative therapy.
  • prophylaxis of invasive fungal infections in specific high risk groups:
    • ­   patients with anticipated neutropenia whilst receiving chemotherapy for acute myeloid leukaemia or myelodysplastic syndrome
    • ­   patients with acute (grade II-IV), or extensive chronic, graft versus host disease and who are receiving intensive immunosuppressive therapy following an allogenic haematopoietic stem cell transplant. 

Data Source

Data to assess the utilisation of posaconazole and other azole antifungals listed on the PBS was obtained from the Department of Human Services (DHS) PBS prescription claims database.

Key Findings

  • In 2017, compared with 2014 (the calendar year prior to listing of the tablet formulation) the number of PBS prescriptions of posaconazole more than doubled.
  • Changes in the utilisation of posaconazole are mainly driven by the prophylaxis indication as this comprises approximately two thirds of prescriptions dispensed. However, towards the end of 2017 there was an upswing in the utilisation of posaconazole for the treatment of ‘other’ fungal infections. As a result, in December 2017 only 53% of prescriptions were for prophylaxis.
  • The number of incident patients commencing posaconazole has increased. In the two years prior to the listing of the tablet form, an average of 73 patients commenced posaconazole each month. In the two years after the tablet listed this increased to 110 patients per month.
  • The increasing utilisation of posaconazole seems to be due to a combination of more patients initiating treatment and slightly longer durations of treatment with the tablets compared with the oral liquid. The cohort of patients initiating on posaconazole for prophylaxis in 2014 had a median time (excluding breaks) on treatment of 86 days. For a cohort initiating from September 2015 to August 2016 (inclusive) the median time on treatment was 96 days.
  • A time to refill analysis shows similar time to dispensing of the tablet and the liquid form indicating that adherence may be similar for the two formulations.
  • The use of voriconazole for prophylaxis of fungal infections is low and remained relatively unchanged following the listing of posaconazole tablets. The increase in posaconazole use cannot be attributed to substitution from voriconazole. 

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