Skip to main content

Cost-effectiveness analysis of anidulafungin in the treatment of candidaemia

Introduction

Echinocandins are recommended first-line treatment for candidaemia [1]. A cost-effectiveness model developed from a UK perspective examined costs and outcomes of antifungal treatment for candidaemia and other forms of invasive candidiasis based on European clinical guidelines [1].

Methods

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 [2]. 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 [3]. 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 [4]. 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.

Results

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.

Conclusion

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 [1]; this model indicates that anidulafungin marries clinical effectiveness and cost-effectiveness.

References

  1. 1.

    Cornely OA: Clin Microbiol Infect. 2012, 18: 19-37.

    Article  CAS  PubMed  Google Scholar 

  2. 2.

    Reboli AC, et al.: N Engl J Med. 2007, 356: 2472-2482. 10.1056/NEJMoa066906

    Article  CAS  PubMed  Google Scholar 

  3. 3.

    Mills EJ, et al.: Ann Clin Microbiol Antimicrob. 2009, 8: 23. 10.1186/1476-0711-8-23

    PubMed Central  Article  PubMed  Google Scholar 

  4. 4.

    Sidhu MK, et al.: Curr Med Res Opin. 2009, 25: 2049-2059. 10.1185/03007990903072565

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Affiliations

Authors

Corresponding author

Correspondence to G Auzinger.

Rights and permissions

This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

Reprints and Permissions

About this article

Cite this article

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

Download citation

Keywords

  • Amphotericin
  • Fluconazole
  • Voriconazole
  • Clinical Success
  • Caspofungin