Cost-effectiveness of three echinocandins and fluconazole in the treatment of candidemia and/or invasive candidiasis in nonneutropenic adult patients.
OBJECTIVE
To estimate the cost-effectiveness of three echinocandins (anidulafungin, caspofungin, and micafungin) and generic fluconazole in the treatment of nonneutropenic adult patients with candidemia and/or invasive candidiasis in intensive care units in Spain.


METHODS
A decision-tree model was applied. The success and safety (hepatic and renal adverse effects) of first-line treatments were obtained from meta-analyses and systematic reviews of clinical trials. In the case of failure, a second-line treatment (liposomal amphotericin B after the echinocandins, or one of the echinocandins after fluconazole) was administered. The duration of the treatments (14 days total) was established by a panel of clinical experts using the Delphi method and according to Infectious Diseases Society of America guidelines. The cost of the medications and renal toxicity were considered. Deterministic and probabilistic sensitivity analysis using Monte Carlo simulations were carried out.


RESULTS
The total cost of the treatment of candidemia and/or invasive candidiasis with anidulafungin, caspofungin, micafungin, and fluconazole was €5,483, €5,968, €6,231, and €2,088, respectively. Anidulafungin was the dominant treatment (more effective, less expensive) compared to micafungin and caspofungin. The cost of achieving one more patient successfully treated with anidulafungin, caspofungin, and micafungin compared to fluconazole was €17,199, €23,962, and €27,339, respectively. The result remained stable, despite modification of the duration of the first-line and second-line treatments, as well as most of the dosing regimens. The probabilistic analysis also remained stable.


CONCLUSIONS
In accordance with this economic study, anidulafungin would produce savings and would be the dominant treatment compared with micafungin and caspofungin in nonneutropenic adult patients with candidemia and/or invasive candidiasis in intensive care units in Spain.
Hospital del Mar (IMIM), Barcelona, Spain.
S
S
Grau
Hospital Universitario Reina Sofía, Córdoba, Spain.
J C
JC
Pozo
Hospital Universitario Reina Sofía, Córdoba, Spain.
E
E
Romá
Hospital Universitario y Politécnico La Fe, Valencia, Spain.
M
M
Salavert
Pfizer SLU, Alcobendas, Spain.
J A
JA
Barrueta
Pfizer SLU, Alcobendas, Spain.
C
C
Peral
Trial Form Support, Madrid, Spain.
I
I
Rodriguez
Health Value, Madrid, Spain.
D
D
Rubio-Rodríguez
Health Value, Madrid, Spain.
C
C
Rubio-Terrés
anidulafungin; candidemia; caspofungin; cost-effectiveness analysis; fluconazole; invasive candidiasis; micafungin