No abstract

Objectives: Early initiation of antifungal treatment for invasive candidiasis is associated with significant reduction of morality. The process of blood culture is timeconsuming and sensitivity is low for the deep-seated infection. Blood culture-guided treatment is mostly delayed. 1,3-beta-D-glucan (BDG) is one of the components in fungal cell wall and BDG assay is recommended for diagnosis of invasive candidiasis. The objective of this study was to evaluate the potential cost-effectiveness of active BDG surveillance for invasive candidiasis in patients admitted to ICU from the perspective of Hong Kong healthcare provider. MethOds: A Markov model was designed to simulate outcomes of active BDG surveillance with preemptive antifungal therapy (surveillance group) and no surveillance (standard care group). Candidiasis-associated outcome measures were mortality rate, quality-adjusted life year (QALY) loss, and direct medical cost. Sensitivity analyses evaluated robustness of model results. Results: In base-case analysis, the surveillance group was more costly (USD1,387 versus USD664) (USD1= HKD7.8) with lower candidiasis-associated mortality rate (0.653 versus 1.426 per 100 ICU admissions) and QALY loss (0.116 versus 0.254) than standard care group. The incremental cost per QALY saved by surveillance group versus standard care group was 5,239 USD/QALY. One-way sensitivity analyses found base-case results to be robust to variation of all model inputs.In probabilistic sensitivity analysis, the probability of surveillance group to be costeffective was 100% at willingness-to-pay (WTP) threshold of ≥ 27,800 USD/QALY (gross domestic product per capita in Hong Kong 2015= USD40,596). cOnclusiOns: Active BDG surveillance in ICU setting appears to be a highly cost-effective strategy to reduce candidiasis-associated mortality rate and save QALY in Hong Kong.

The German submission requires a comparison of the drug to be assessed with the appropriate comparative therapy (ACT). In contrast, for the NICE submission an economic evaluation is required beside the clinical evidence of all the drugs in the specific disease area. The assessment of vedolizumab was performed by the IQWiG for both indications simultaneously whereas NICE did the assessment for the two indications separately. The G-BA defined either adalimumab (ADA) or infliximab (INF) as ACT. As a direct comparison was not possible an indirect comparison was performed but the results were not considered by IQWiG due to different study design. No additional benefit was determined in both indications. By contrast network meta-analyses (NMA) were performed for the NICE submissions. Although NICE noticed that the NMA results are afflicted with uncertainties, vedolizumab was classified as cost-effective in both indications. ConClusions: The G-BA defined an ACT whereas the data of all drugs approved in disease areas are considered in the NICE submission. Indirect comparisons were not considered by IQWiG. In contrast, the results of the NMAs performed for the NICE submissions were discussed. The focus of the G-BA is on the assessment of the additional benefit against the ACT. That result is the basis for the price negotiation. By contrast, NICE is primarily interested in the cost-effectiveness of a drug.