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Jeck J, Jakobs F, Kurte MS, Cornely OA, Kron F. Health-economic modelling of cost savings due to the use of rezafungin based on a German cost-of-illness study of candidiasis. JAC Antimicrob Resist 2023; 5:dlad079. [PMID: 37342199 PMCID: PMC10279419 DOI: 10.1093/jacamr/dlad079] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 06/01/2023] [Indexed: 06/22/2023] Open
Abstract
Objective Candida species are responsible for fungal diseases and the development of nosocomial bloodstream infections. Treatment is resource-intensive and economically challenging for healthcare systems. Cost analyses of drugs against candidiasis, such as rezafungin, are thus of great interest to healthcare payers. Methods We conducted a cost-of-illness study of patients with Candida infections based on real-word data of the Department I of Internal Medicine, University Hospital Cologne (Germany) between 2016 and 2021. Health-economic parameters were analysed to describe the economic impact of Candida infections. Potential cost savings due to the administration of rezafungin were modelled for patients with invasive candidiasis or candidaemia based on a 5 day reduction of ICU length of stay (LOS) shown by the STRIVE study. Results We found 724 cases (652 patients) with Candida infections, of which 61% received ICU treatment (n = 442) and 29% were mechanically ventilated (n = 207). Twenty-six percent died during hospitalization (n = 185). Median LOS was 25 and 15 days, on normal wards and ICU, respectively. Median total treatment costs per case accounted for €22 820. Based on the ICU LOS reduction, the retrospective model showed a median cost-saving potential of €7175 per hospital case with invasive candidiasis or candidaemia. Accumulated cost savings for 37 patients of €283 335 were found. Conclusions Treatment of candidiasis is cost intensive due to increased hospital LOS. The ICU LOS reduction rezafungin showed in STRIVE would lead to sustainable cost savings.
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Affiliation(s)
- Julia Jeck
- Department I of Internal Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Straße 62, 50937 Cologne, Germany
- VITIS GmbH, Am Morsdorfer Hof 12, 50933 Cologne, Germany
| | - Florian Jakobs
- Department of Haematology and Stem Cell Transplantation, Faculty of Medicine and Essen University Hospital, University of Duisburg-Essen, Hufelandstraße 55, 45147 Essen, Germany
| | - Melina S Kurte
- VITIS GmbH, Am Morsdorfer Hof 12, 50933 Cologne, Germany
| | - Oliver A Cornely
- Department I of Internal Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Straße 62, 50937 Cologne, Germany
- Center for Integrated Oncology Cologne (CIO ABCD), Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Straße 28 62, 50937 Cologne, Germany
- Clinical Trials Centre Cologne (ZKS Köln), Faculty of Medicine and University Hospital Cologne, University of Cologne, Gleueler Straße 269, 50935 Cologne, Germany
- CECAD Cologne, Translational Research, Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), Faculty of Medicine and University Hospital Cologne, University of Cologne, Joseph-Stelzmann-Straße 26, 50931 Cologne, Germany
- Excellence Centre for Medical Mycology (ECMM), Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Straße 62, 50937 Cologne, Germany
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Pagès A, Iriart X, Molinier L, Georges B, Berry A, Massip P, Juillard-Condat B. Cost Effectiveness of Candida Polymerase Chain Reaction Detection and Empirical Antifungal Treatment among Patients with Suspected Fungal Peritonitis in the Intensive Care Unit. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2017; 20:1319-1328. [PMID: 29241891 DOI: 10.1016/j.jval.2017.06.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/11/2016] [Revised: 06/01/2017] [Accepted: 06/18/2017] [Indexed: 06/07/2023]
Abstract
BACKGROUND Mortality from intra-abdominal candidiasis in intensive care units (ICUs) is high. It takes many days for peritoneal-fluid fungal culture to become positive, and the recommended empirical antifungal therapy involves excessive costs. Polymerase chain reaction (PCR) should produce results more rapidly than fungal culture. OBJECTIVES To perform a cost-effectiveness analysis of the combination of several diagnostic and therapeutic strategies to manage Candida peritonitis in non-neutropenic adult patients in ICUs. METHODS We constructed a decision tree model to evaluate the cost effectiveness. Cost and effectiveness were taken into account in a 1-year time horizon and from the French National Health Insurance perspective. Six strategies were compared: fluconazole or echinocandin as an empirical therapy, plus diagnosis by fungal culture or detection by PCR of all Candida species, or use of PCR to detect most fluconazole-resistant Candida species (i.e., Candida krusei and Candida glabrata). RESULTS The use of fluconazole empirical treatment and PCR to detect all Candida species is more cost effective than using fluconazole empirical treatment without PCR (incremental cost-effectiveness ratio of €40,055/quality-adjusted life-year). Empirical treatment with echinocandin plus PCR to detect C. krusei and C. glabrata is the most effective strategy, but has an incremental cost-effectiveness ratio of €93,776/quality-adjusted life-year. If the cost of echinocandin decreases, then strategies involving PCR plus empirical echinocandin become more cost-effective. CONCLUSIONS Detection by PCR of all Candida species and of most fluconazole-resistant Candida species could improve the cost-effectiveness of fluconazole and echinocandin given to non-neutropenic patients with suspected peritoneal candidiasis in ICUs.
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Affiliation(s)
| | - Xavier Iriart
- CHU de Toulouse, Laboratoire de parasitologie et mycologie, Toulouse, France; Inserm U1043/CNRS UMR5282/CPTP, UPS Université de Toulouse III, Toulouse, France
| | - Laurent Molinier
- CHU de Toulouse, Département d'Information Médicale, Toulouse, France; Inserm, UMR1027, UPS Université de Toulouse III, Toulouse, France
| | - Bernard Georges
- CHU de Toulouse, Réanimation Polyvalente, Hôpital Rangueil, Toulouse, France
| | - Antoine Berry
- CHU de Toulouse, Laboratoire de parasitologie et mycologie, Toulouse, France; Inserm U1043/CNRS UMR5282/CPTP, UPS Université de Toulouse III, Toulouse, France
| | - Patrice Massip
- CHU de Toulouse, Service des Maladies Infectieuses et Tropicales, Toulouse, France
| | - Blandine Juillard-Condat
- CHU de Toulouse, Pharmacie, Toulouse, France; Inserm, UMR1027, UPS Université de Toulouse III, Toulouse, France
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Pharmacoeconomic evaluation of micafungin versus caspofungin as definitive therapy for candidaemia and invasive candidiasis (IC) in Turkey. Eur J Clin Microbiol Infect Dis 2017; 37:537-544. [PMID: 29185089 DOI: 10.1007/s10096-017-3147-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2017] [Accepted: 11/15/2017] [Indexed: 01/03/2023]
Abstract
Micafungin was shown to be as efficacious as caspofungin in treating patients with candidaemia and invasive candidiasis (IC). However, it remains unknown if micafungin or caspofungin is a cost-effective definitive therapy for candidaemia and IC in Turkey. The present study aimed to determine the economic impact of using micafungin versus caspofungin for treatment of candidaemia and IC in the Turkish setting. A decision analytic model was constructed and was populated with data (i.e. transition probabilities, duration of initial antifungal treatment, reasons for treatment failure, percentage of patients who stepped down to oral fluconazole, and duration on oral fluconazole) obtained from a published randomised clinical trial. Cost inputs were derived from the latest Turkish resources while data that were not readily available in the literature were estimated by expert panels. One-way sensitivity analyses, threshold analyses, scenario analyses and probabilistic sensitivity analyses were conducted. Caspofungin (€2693) incurred a lower total cost than micafungin (€4422), with a net cost saving of €1729 per treated patient. Drug acquisition cost was the main cost driver for both study arms. The model outcome was robust over wide variations (of ±100.0% from the base case value) for all input parameters except for micafungin drug cost and the duration of initial treatment with micafungin. Caspofungin appears to be a cost-saving option in treating candidaemia and IC from the Turkish hospital perspective.
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Neoh CF, Senol E, Kara A, Dinleyici EC, Turner SJ, Kong DCM. Cost-effectiveness analysis of anidulafungin vs fluconazole for the treatment of invasive candidiasis (IC) in Turkey. Mycoses 2017; 60:714-722. [PMID: 28699297 DOI: 10.1111/myc.12651] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Revised: 05/31/2017] [Accepted: 06/01/2017] [Indexed: 01/05/2023]
Abstract
Anidulafungin has been shown to be non-inferior to, and possibly more efficacious, than fluconazole in treating patients with invasive candidiasis (IC). This study aimed to determine the cost-effectiveness of anidulafungin vs fluconazole for treatment of IC in the Turkish setting. A decision analytic model was constructed to depict downstream economic consequences of using anidulafungin or fluconazole for treatment of IC in the Turkish hospitals. Transition probabilities (ie treatment success, observed or indeterminate treatment failures) were obtained from a published randomised clinical trial. Cost inputs were from the latest Turkish resources. Data not available in the literature were estimated by expert panels. Sensitivity analyses were performed to assess the robustness of the model outcome. While anidulafungin [TL 17 171 (USD 4589)] incurred a higher total cost than fluconazole [TL 8233 (USD 2200) per treated patient, treatment with anidulafungin was estimated to save an additional 0.58 life-years, with an incremental cost-effectiveness ratio of TL 15 410 (USD 4118) per life-years saved. Drug acquisition cost and hospitalisation were the main cost drivers for anidulafungin and fluconazole arms respectively. The model findings were robust over a wide range of input variables except for anidulafungin drug cost. Anidulafungin appears to be a cost-effective therapy in treating IC from the Turkish hospital perspective.
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Affiliation(s)
- Chin Fen Neoh
- Collaborative Drug Discovery Research (CDDR) Group, Faculty of Pharmacy, Universiti Teknologi MARA, Puncak Alam, Malaysia
| | - Esin Senol
- Department of Infectious Diseases, Gazi University, Ankara, Turkey
| | - Ates Kara
- Department of Paediatric Infectious Diseases, Hacettepe University, Ankara, Turkey
| | - Ener Cagri Dinleyici
- Department of Paediatrics, Faculty of Medicine, Eskisehir Osmangazi University, Eskisehir, Turkey
| | | | - David C M Kong
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, VIC, Australia.,Pharmacy Department, Ballarat Health Services, Ballarat, VIC, Australia
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Ou HT, Lee TY, Chen YC, Charbonneau C. Pharmacoeconomic analysis of antifungal therapy for primary treatment of invasive candidiasis caused by Candida albicans and non-albicans Candida species. BMC Infect Dis 2017; 17:481. [PMID: 28693479 PMCID: PMC5504557 DOI: 10.1186/s12879-017-2573-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Accepted: 06/27/2017] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Cost-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. METHODS A 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. RESULTS For 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. CONCLUSIONS Echinocandins, especially anidulafungin, appear to be cost-effective for invasive candidiasis caused by C. albicans and non-albicans Candida species in Taiwan.
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Affiliation(s)
- Huang-Tz Ou
- Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan. .,Department of Pharmacy, College of Medicine, National Cheng Kung University, Tainan, Taiwan. .,Department of Pharmacy, National Cheng Kung University Hospital, Tainan, Taiwan.
| | - Tsung-Ying Lee
- Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Yee-Chun Chen
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.,Department of Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
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Zaragoza R, Ramírez P, Borges M, Pemán J. [Update on invasive candidiasis in non-neutropenic critically ill adult patients]. Rev Iberoam Micol 2016; 33:145-51. [PMID: 27395022 DOI: 10.1016/j.riam.2016.03.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2015] [Revised: 02/23/2016] [Accepted: 03/02/2016] [Indexed: 12/29/2022] Open
Abstract
Invasive candidiasis in non-neutropenic critically ill patients remains a challenge for clinicians due to its association with high morbidity and mortality rates, increased incidence, and health-care costs. It is well known that early diagnosis and treatment are associated with a better prognosis. For these reasons a thorough update has been performed in this setting focused on recent Spanish epidemiology, new predictive scores and microbiological tests such as mannan antigen, mannan antibodies, Candida albicans germ-tube antibodies or (1→3)-β-D-glucan detection, molecular techniques for the detection of fungal-specific DNA, advances in antifungal treatment and educational programs in Spain. An early diagnostic and therapeutic algorithm is proposed based on the combination of scores and microbiological test. The aim of this review is to provide physicians with the best information available in order to improve the prognosis of these patients.
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Affiliation(s)
- Rafael Zaragoza
- Unidad de Sepsis, Servicio de Medicina Intensiva, Hospital Universitario Dr. Peset, Valencia, España.
| | - Paula Ramírez
- Servicio de Medicina Intensiva, Hospital Universitario y Politécnico La Fe, Valencia, España
| | - Marcio Borges
- Unidad de Sepsis, Servicio de Medicina Intensiva, Hospital Sont Llàtzer, Palma de Mallorca, España
| | - Javier Pemán
- Servicio de Microbiología, Hospital Universitario La Fe, Valencia, España
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Renau AI, García-Vidal C, Salavert M. Enfermedades invasivas por hongos levaduriformes en pacientes quemados graves. Rev Iberoam Micol 2016; 33:160-9. [DOI: 10.1016/j.riam.2016.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2016] [Accepted: 02/10/2016] [Indexed: 10/21/2022] Open
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Grau S, Pozo JC, Romá E, Salavert M, Barrueta JA, Peral C, Rodriguez I, Rubio-Rodríguez D, Rubio-Terrés C. Cost-effectiveness of three echinocandins and fluconazole in the treatment of candidemia and/or invasive candidiasis in nonneutropenic adult patients. CLINICOECONOMICS AND OUTCOMES RESEARCH 2015; 7:527-35. [PMID: 26508881 PMCID: PMC4610791 DOI: 10.2147/ceor.s91587] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
OBJECTIVE To estimate the cost-effectiveness of three echinocandins (anidulafungin, caspofungin, and micafungin) and generic fluconazole in the treatment of nonneutropenic adult patients with candidemia and/or invasive candidiasis in intensive care units in Spain. MATERIALS AND METHODS A decision-tree model was applied. The success and safety (hepatic and renal adverse effects) of first-line treatments were obtained from meta-analyses and systematic reviews of clinical trials. In the case of failure, a second-line treatment (liposomal amphotericin B after the echinocandins, or one of the echinocandins after fluconazole) was administered. The duration of the treatments (14 days total) was established by a panel of clinical experts using the Delphi method and according to Infectious Diseases Society of America guidelines. The cost of the medications and renal toxicity were considered. Deterministic and probabilistic sensitivity analysis using Monte Carlo simulations were carried out. RESULTS The total cost of the treatment of candidemia and/or invasive candidiasis with anidulafungin, caspofungin, micafungin, and fluconazole was €5,483, €5,968, €6,231, and €2,088, respectively. Anidulafungin was the dominant treatment (more effective, less expensive) compared to micafungin and caspofungin. The cost of achieving one more patient successfully treated with anidulafungin, caspofungin, and micafungin compared to fluconazole was €17,199, €23,962, and €27,339, respectively. The result remained stable, despite modification of the duration of the first-line and second-line treatments, as well as most of the dosing regimens. The probabilistic analysis also remained stable. CONCLUSION In accordance with this economic study, anidulafungin would produce savings and would be the dominant treatment compared with micafungin and caspofungin in nonneutropenic adult patients with candidemia and/or invasive candidiasis in intensive care units in Spain.
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Affiliation(s)
- S Grau
- Hospital del Mar (IMIM), Barcelona, Spain
| | - JC Pozo
- Hospital Universitario Reina Sofía, Córdoba, Spain
| | - E Romá
- Hospital Universitario Reina Sofía, Córdoba, Spain
| | - M Salavert
- Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | | | - C Peral
- Pfizer SLU, Alcobendas, Spain
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Tagliaferri E, Menichetti F. Treatment of invasive candidiasis: between guidelines and daily clinical practice. Expert Rev Anti Infect Ther 2015; 13:685-9. [PMID: 25818660 DOI: 10.1586/14787210.2015.1029916] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Invasive candidiasis, including candidemia (IC/C), is a major cause of morbidity and mortality among hospitalized patients. While incidence is higher in intensive care units, the majority of cases of candidemia are documented in medical wards. Although Candida albicans is still the most frequently isolated species, IC/C due to non-albicans species, usually less susceptible to fluconazole, is increasing. Early identification of patients at risk, knowledge of local epidemiology and prompt efforts to define etiologic diagnosis play a pivotal role for appropriateness. Starting therapy with an echinocandin, switching then to fluconazole when possible, seems to represent a potentially useful strategy for the management of IC/C. The choice between the three echinocandins should be based on the specific indications, pharmacokinetic/pharmacodynamic profile, clinical experience and relative cost.
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Affiliation(s)
- Enrico Tagliaferri
- UOC Malattie Infettive, Azienda Ospedaliera Universitaria Pisana, Pisa, Italy
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