title: Cost-effectiveness analysis of anidulafungin versus fluconazole for the treatment of invasive candidiasis.
abstract: BACKGROUND
  Anidulafungin was found to be non-inferior to and possibly more efficacious than fluconazole for treatment of invasive candidiasis (IC) in a major randomized clinical trial (RCT). There are no data comparing the cost-effectiveness between azoles and echinocandins in treating IC. This economic analysis investigated the cost-effectiveness of anidulafungin compared with fluconazole for treatment of IC in an Australian setting.
  
  
  METHODS
  A decision analytic model was constructed to capture downstream consequences of using either agent for treatment of IC. The main outcomes analysed in the model were treatment success and treatment failure (observed and indeterminate). Outcome probabilities and treatment pathways were derived from a published RCT. Resources used were estimated by an expert panel and cost inputs were derived from the latest Australian resources. The analysis was based on an Australian hospital perspective. Sensitivity analyses were conducted using Monte Carlo simulation.
  
  
  RESULTS
  Anidulafungin (AU$74,587) had a higher total cost than fluconazole (AU$60,945) per successfully treated patient, primarily due to its higher acquisition cost. Hospitalization was the main cost driver for both comparators. However, when the rates of mortality in both treatment arms were considered, treatment with anidulafungin was expected to save an additional 0.53 life-years, with an incremental cost-effectiveness ratio (ICER) of AU$25 740 per life-years saved, which was below the implicit ICER threshold value for Australia. The results were robust over a wide range of variables.
  
  
  CONCLUSIONS
  This is the first economic evaluation of anidulafungin versus fluconazole in the treatment of IC in Australia. Anidulafungin appears to be a cost-effective option.
authors.affiliation: Department of Pharmacy Practice, Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, 381 Royal Parade, Parkville, Victoria 3052, Australia.
authors.forename: Chin Fen
authors.initials: CF
authors.lastname: Neoh
authors.forename: Danny
authors.initials: D
authors.lastname: Liew
authors.forename: Monica
authors.initials: M
authors.lastname: Slavin
authors.forename: Debbie
authors.initials: D
authors.lastname: Marriott
authors.forename: Sharon C-A
authors.initials: SC
authors.lastname: Chen
authors.forename: Orla
authors.initials: O
authors.lastname: Morrissey
authors.forename: Kay
authors.initials: K
authors.lastname: Stewart
authors.forename: David C M
authors.initials: DC
authors.lastname: Kong
mesh_terms: D000328:Adult; D000368:Aged; D000077612:Anidulafungin; D000935:Antifungal Agents / Q000191:economics / Q000627:therapeutic use*; D001315:Australia; D058365:Candidiasis, Invasive / Q000188:drug therapy*; D003362:Cost-Benefit Analysis; D054714:Echinocandins / Q000191:economics / Q000627:therapeutic use*; D005260:Female; D015725:Fluconazole / Q000191:economics / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015233:Models, Statistical; D016032:Randomized Controlled Trials as Topic; D017211:Treatment Failure; D016896:Treatment Outcome
chemical_list: D000935:Antifungal Agents; D054714:Echinocandins; D015725:Fluconazole; D000077612:Anidulafungin