Noemi Muszbek, Alisha Angdembe, Carolina Garcia-Vidal, Inga Bielicka, Keith R Abrams, Keith Tolley, Markus Ruhnke, Maximilian Lebmeier, Neil Hawkins, Nick Manamley, Sara Dickerson
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引用次数: 0
Abstract
Background: Invasive candidiasis (IC), life-threatening fungal infections with high economic burden, are often treated first-line with daily intravenous echinocandins. A new once weekly echinocandin, rezafungin, demonstrated statistically non-inferior efficacy and numerically shorter intensive care unit (ICU) stay compared to caspofungin in clinical trials, offering potential for earlier discharge.
Objective: To assess the cost-effectiveness of rezafungin versus daily echinocandins for the treatment of IC from a UK healthcare perspective.
Methods: An economic model was developed including a short-term decision tree (treatment duration ≤ 30 days) and a long-term Markov model (for lifetime outcomes). Considering the impact IC has on a patient's life expectancy and quality of life, a cost-utility analysis was performed. A cost-minimisation analysis assuming similar efficacy among echinocandins was included as scenario analysis. Treatment response was assessed at days 5/14 with nonresponders switching to second-line treatment. Patients with negative repeat blood cultures could step down to oral fluconazole. Rezafungin's weekly administration was estimated to lead to early discharge for 16% of patients. Risk of death was included. Efficacy and resource use estimates were from pooled trial data. Unit costs, utilities, long-term mortality were from published literature and UK databases.
Results: Rezafungin was estimated to be cost-saving compared to daily echinocandins (discounted incremental costs: -£6028 to -£6727 vs. daily echinocandins). Quality-adjusted life-years (QALYs) were similar (incremental QALY: 0.03 vs. daily echinocandins), resulting in rezafungin being cost-effective. Results were most sensitive to varying mortality and ICU length of stay.
Conclusion: Once weekly rezafungin is a cost-saving and cost-effective treatment option in IC from the UK healthcare perspective.
期刊介绍：
The journal Mycoses provides an international forum for original papers in English on the pathogenesis, diagnosis, therapy, prophylaxis, and epidemiology of fungal infectious diseases in humans as well as on the biology of pathogenic fungi.
Medical mycology as part of medical microbiology is advancing rapidly. Effective therapeutic strategies are already available in chemotherapy and are being further developed. Their application requires reliable laboratory diagnostic techniques, which, in turn, result from mycological basic research. Opportunistic mycoses vary greatly in their clinical and pathological symptoms, because the underlying disease of a patient at risk decisively determines their symptomatology and progress. The journal Mycoses is therefore of interest to scientists in fundamental mycological research, mycological laboratory diagnosticians and clinicians interested in fungal infections.
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