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Cost-effectiveness analysis of the therapy for the invasive Candidiasis in Colombia

2010; Elsevier BV; Volume: 14; Linguagem: Inglês

10.1016/j.ijid.2010.02.1757

1878-3511

Francisco Molina, Jorge Alberto Cortés, HA Caceres, R. Soto, Elkin Lemos,

Antifungal resistance and susceptibility

Background: Candidiasis is a nosocomial infection associated to considerable mortality and high economic impact. The echinocandins are a new class of therapeutic medications that have shown to be effective in treating candidemia and other forms of invasive candidiasis; however, cost of amphotericin B dose is lower. Hypothesis: Is anidulafungin (ANI) costeffective compared to caspofungin (CAS), and amphotericin B (AMB) in the treatment of invasive candidiasis in non-neutropenic patients hospitalized in Intensive Care Units (ICU) when the fluconazole is not a choice, from a third-party payer perspective. Methods: A decision tree was designed to assess the cost-effectiveness of the three medications and this was validated by 2 critical care specialists and 2 infectologist. The model simulated costs and effectiveness in a 14-week-period. Effectiveness measure was the rate of survival and the main outcome was saved Life Years (LYs). Clinical efficacy and node probabilities were obtained from a published meta-analysis that was identified by systematic literature review. This study estimated the direct costs associated with invasive candidiasis treatment including antifungal drugs, hospitalization, and costs associated with adverse events. Medical costs were extracted from 7 ICUs of 3 major cities and drug costs were taken from a standard colombian costing source. The incremental cost per successfully treated patient was calculated and the one way sensitivity analysis was performed. Results: Patients treated with ANI experienced the higher outcomes (13.7 LYs) followed by AMB (12.1 LYs) and CAS (11.7 LYs). Mean cost per patient was lower with AMB (US$4,131) followed by ANI (US$6,001) and CAS (US$6,444). Based on ICERs, ANI was the dominant therapy compared to CAS and ANI was cost-effective compared to AMB (ICER US$1.228). Conclusion: Anidulafungin represents the cost-effective treatment of choice when compared to caspofungin and amphotericin B for the invasive candidiasis in Non-neutropenic patients in Colombia. Abstracts for SupplementInternational Journal of Infectious DiseasesVol. 14Preview Full-Text PDF Open Archive