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PIN31 Cost-Effectiveness Analysis of Antifungal Treatments Available in Colombia for the Treatment of Invasive Candidiasis

2012; Elsevier BV; Volume: 15; Issue: 4 Linguagem: Inglês

10.1016/j.jval.2012.03.1307

1524-4733

Francisco Molina, Jorge Alberto Cortés, R. Soto, Elkin Lemos, M.V. Gutierrez-Ardila, S.M. Nuñez,

Public Health in Brazil

Candidemia accounts for 50 to 70% of the manifestations of invasive candidiasis (IC) and in Colombia Candida albicans is the most frequently isolated specie in IC (43.6%). The emergence of new antifungal agents such as echinocandins family therapy provides great opportunities to manage candidemia, with favorable safety profile and broad spectrum fungicide. The purpose of this study was to evaluate the cost-effectiveness of multiple treatments for non-neutropenic critically ill patients hospitalized in an intensive care unit (ICU) with highly suspected or confirmed IC comparing amphotericin B, anidulafungin, and caspofungin from the third-party payer perspective in Colombia. A decision-tree model was developed to assess the cost-effectiveness of empiric treatments for IC, using a time horizon of 14 weeks. Comparators were: amphotericin B (0,6mg/kg/day), anidulafungin (100mg/day), and caspofungin (50mg/day). Effectiveness data and adverse event rates for comparators were obtained through a Colombian meta-analysis using the results from a systematic review. Direct medical costs were gathered from the Colombian Tariff Manual (SOAT) and acquisition costs were retrieved from the 2011 SISMED report from Colombia. All data were validated through a Colombian Delphi Panel who estimated schemes for IC treatment (drugs, hospitalization, and medical manage associated with adverse events: such as nephrotoxicity and hypokalemia). Effectiveness was expressed through life years gained (LYG). Incremental cost per life year gained (ICER) and sensitivity analyses were performed to test model robustness. Anidulafungin showed to be cost-saving vs. caspofungin reducing overall costs (2011 US$) by US$924.80 and gaining additional 0.47 LYG. Likewise, anidulafungin was highly cost-effective compared to amphotericin B (ICER $1153.67/LYG); due to rates reduction of side effect events: anidulafungin 24.4%, caspofungin 42.1% and amprothericin B 75.2% and its associated costs. In Colombia, anidulafungin is the most cost effective option for the treatment of IC in critically ill patients hospitalized at ICU.