Pharmacoeconomic analysis of antifungal therapy for primary treatment of invasive candidiasis caused by Candida albicans and non-albicans Candida species
Journal
BMC Infectious Diseases
Journal Volume
17
Journal Issue
1
Pages
481
Date Issued
2017
Author(s)
Abstract
Background: Cost-effectiveness studies of echinocandins for the treatment of invasive candidiasis, including candidemia, are rare in Asia. No study has determined whether echinocandins are cost-effective for both Candida albicans and non-albicans Candida species. There have been no economic evaluations that compare non-echinocandins with the three available echinocandins. This study was aimed to assess the cost-effectiveness of individual echinocandins, namely caspofungin, micafungin, and anidulafungin, versus non-echinocandins for C. albicans and non-albicans Candida species, respectively. Methods: A decision tree model was constructed to assess the cost-effectiveness of echinocandins and non-echinocandins for invasive candidiasis. The probability of treatment success, mortality rate, and adverse drug events were extracted from published clinical trials. The cost variables (i.e., drug acquisition) were based on Taiwan's healthcare system from the perspective of a medical payer. One-way sensitivity analyses and probability sensitivity analyses were conducted. Results: For treating invasive candidiasis (all species), as compared to fluconazole, micafungin and caspofungin are dominated (less effective, more expensive), whereas anidulafungin is cost-effective (more effective, more expensive), costing US$3666.09 for each life-year gained, which was below the implicit threshold of the incremental cost-effectiveness ratio in Taiwan. For C. albicans, echinocandins are cost-saving as compared to non-echinocandins. For non-albicans Candida species, echinocandins are cost-effective as compared to non-echinocandins, costing US$652 for each life-year gained. The results were robust over a wide range of sensitivity analyses and were most sensitive to the clinical efficacy of antifungal treatment. Conclusions: Echinocandins, especially anidulafungin, appear to be cost-effective for invasive candidiasis caused by C. albicans and non-albicans Candida species in Taiwan. ? 2017 The Author(s).
SDGs
Other Subjects
amphotericin B; anidulafungin; caspofungin; echinocandin; fluconazole; micafungin; anidulafungin; antifungal agent; caspofungin; echinocandin; fluconazole; lipopeptide; micafungin; Article; Candida; Candida albicans; clinical outcome; cost control; cost effectiveness analysis; drug cost; drug efficacy; health care system; hospitalization; human; invasive candidiasis; mortality rate; nephrotoxicity; nonhuman; sensitivity analysis; Candida; Candida albicans; candidemia; Candidiasis, Invasive; cost benefit analysis; drug effects; economics; mortality; pathogenicity; pharmacoeconomics; Taiwan; treatment outcome; Antifungal Agents; Candida; Candida albicans; Candidemia; Candidiasis, Invasive; Cost-Benefit Analysis; Echinocandins; Economics, Pharmaceutical; Fluconazole; Humans; Lipopeptides; Taiwan; Treatment Outcome
Publisher
BioMed Central Ltd.
Type
journal article