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Cost-effectiveness analysis of anidulafungin in the treatment of candidaemia
Critical Care volume 17, Article number: P87 (2013)
Costs and treatment outcomes with the echinocandin anidulafungin were compared with caspofungin, micafungin, fluconazole, voriconazole and amphotericin B. The model included non-neutropenic patients aged ≥16 years with confirmed candidaemia/another form of invasive candidiasis receiving intravenous first-line treatment . Patients were categorised as a clinical success or failure (patients with persistent/breakthrough infection); frequency data for each outcome were taken from a mixed-treatment comparison . Successfully treated patients switched to oral therapy. Clinical failures switched to a different antifungal class. It was assumed that second-line treatment duration was equivalent to that of first-line treatment and only two lines of therapy were required to treat infection. Other inputs were all-cause 6-week mortality, cost of treatment-related adverse events (AEs) and other medical resource use costs. Life-years were calculated using a published model . Antifungal agent-related AEs were taken from the product label/literature. Resource use was derived from the literature and discussion with clinical experts. Drug acquisition/ administration costs were taken from standard UK costing sources.
First-line anidulafungin for treatment of candidaemia was cost-effective per life-year gained versus fluconazole (incremental cost-effectiveness ratio £813). Anidulafungin was cost saving versus caspofungin and micafungin in terms of life-years gained due to lower ICU costs and a higher rate of survival combined with a higher probability of clinical success.
Anidulafungin was cost-effective compared with fluconazole for treatment of candidaemia and was cost saving versus other echinocandins in the UK. European guidelines recommend echinocandins as first-line treatments for candidaemia ; this model indicates that anidulafungin marries clinical effectiveness and cost-effectiveness.
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Auzinger, G., Playford, G., Graham, C. et al. Cost-effectiveness analysis of anidulafungin in the treatment of candidaemia. Crit Care 17, P87 (2013). https://doi.org/10.1186/cc12025
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