OBJECTIVE: Candidemia is a nosocomial bloodstream infection associated with considerable mortality and is costly to treat. A new echinocandin, anidulafungin, has been shown to be effective in treating candidemia and other forms of invasive candidiasis (henceforth, candidemia). The objective of this study was to compare cost and outcomes of anidulafungin with current standard of care in Canada, and fluconazole, for the treatment of candidemia in non-neutropenic adult patients.
METHODS: A decision tree was constructed to examine the cost-effectiveness of anidulafungin compared with fluconazole, in the treatment of candidemia. Data on treatment success, renal toxicity, duration of intravenous and oral antifungal treatment, and patient survival were obtained from a published, randomized, double-blind trial comparing anidulafungin with fluconazole. Separate analyses of the clinical trial data were performed to obtain length of stay in the intensive care unit and general ward for each arm of the trial. Therapy switching and additional resource use were obtained from surveys of Canadian clinicians. Medical and drug costs were taken from standard Canadian costing sources and the published literature. The incremental cost per successfully treated patient was calculated. Sensitivity analyses were performed.
RESULTS: The percentage of successfully treated patients is higher for patients treated with anidulafungin than with fluconazole (74.02% vs. 56.78%). Treating with anidulafungin results in higher antifungal drug costs $4792 vs. $2651; however, overall costs are lower for treatment with anidulafungin than for treatment with fluconazole ($62,949 vs. $65,954, respectively) due to an offset in other medical costs, mainly in ICU where anidulafungin is associated with savings of $6707. Thus, treating with anidulafungin is cost-savings (less costly and more efficacious) when compared to treating with fluconazole.
CONCLUSION: Anidulafungin has demonstrated improved clinical efficacy versus standard of care in treating candidemia. Despite an increase in drug costs, treating candidemia with anidulafungin is a cost-saving strategy.
