Pharmacoeconomic analysis of antifungal therapy for primary treatment of invasive candidiasis caused by Candida albicans and non-albicans Candida species

Abstract

BackgroundCost-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.MethodsA 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.ResultsFor 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.ConclusionsEchinocandins, especially anidulafungin, appear to be cost-effective for invasive candidiasis caused by C. albicans and non-albicans Candida species in Taiwan.Electronic supplementary materialThe online version of this article (doi:10.1186/s12879-017-2573-8) contains supplementary material, which is available to authorized users.

MDR1 overexpression combined with ERG11 mutations induce high-level fluconazole resistance in Candida tropicalis clinical isolates

“…Currently, azole antifungal agents are widely used in the battle against clinical Candida infections [ 5 ]. Due to the lower risk of side effects and low cost associated with fluconazole, it has become one of the most commonly used antifungals [ 6 ]. Until recently, C. tropicalis was susceptible to azole and other antifungal agents.…”

Severe acute pancreatitis with blood infection by Candida glabrata complicated severe agranulocytosis: a case report

“…With the aging of hospitalized patients and the coexistence of many basic diseases, multiple invasive diagnostic procedures, such as broad-spectrum antibiotics, glucocorticoids, immunosuppressive agents, chemotherapy drugs, central venous catheterization and hemodialysis are widly performed [6, 7]. Therefore, incidence of acquired candidiasis and the associated mortality rate have increased [8, 9].…”

Biomarker-guided antifungal stewardship policies for patients with invasive candidiasis

“…In addition, empirical or prophylactic SAT was recommended by guidelines immediately after the emergence of clinical symptoms attributable to IC (i.e., suspected IC cases) [6, 68, 69]. However, these therapy regimens cost a lot [56, 70, 71]; in this regard, anidulafungin and caspofungin cost $112 per 50 mg vial and 395$ per 70 mg vial, respectively. Furthermore, the cost of one-day intravenous administration of fluconazole has been estimated as $88 [70].…”

“…Moreover, the new formulations of old antifungals, such as the one developed in liposomal amphotericin, and introduction of highly effective and completely novel class of antifungals (e.g., echinocandins) are good examples of our remarkable progress in medical mycology [55, 56]. However, from another point of view, the enhancement of survival rate and quality of life have been obtained at the expensive price of the emergence of new resistant fungal strains and imposition of a heavy economic burden on the national healthcare system [21, 57].…”