Pharmacoeconomic analysis of antifungal therapy for primary treatment of invasive candidiasis caused by Candida albicans and non-albicans Candida species

Ou, Huang-Tz; Lee, Tsung-Ying; Chen, Yee-Chun; Charbonneau, Claudie

doi:10.1186/s12879-017-2573-8

Table 1 Summary of model parameters

From: Pharmacoeconomic analysis of antifungal therapy for primary treatment of invasive candidiasis caused by Candida albicans and non-albicans Candida species

Variable	Value [ref.]
Probability of success rate (%)
All species
Fluconazole	63 [22]
Anidulafungin	77.49 [22]
Micafungin	75.98 [22]
Caspofungin	76.10 [22]
C. albicans specific
Echinocandins	81 [8]
Non-echinocandins	22^a [7]
Non-albicans specific
Echinocandins	71 [8]
Non-echinocandins	71^a [7]
Probability of mortality (%)
All species
Fluconazole	28.44 [22]
Anidulafungin	20.75 [22]
Micafungin	39.16 [22]
Caspofungin	33.83 [22]
C. albicans specific
Echinocandins	19 [Pfizer, Data in file]
Non-echinocandins	35^a [7]
Non-albicans specific
Echinocandins	26 [Pfizer, Data in file]
Non-echinocandins	50^a [7]
Percentage that die during therapy (%)	23.26 [25]
Life expectancy, mean (years)	9.12 [9]
Length of IV treatment for patients with treatment success and then survival (days)	14 [6, 18]
Major drug adverse events
Nephrotoxicity probability for amphotericin B (%)	33.7 [26]
Relative risk of nephrotoxicity of fluconazole compared with that of amphotericin B	0.22 (95% CI, 0.15–0.32) [22]
Relative risk of nephrotoxicity of echinocandins compared with that of amphotericin B	0.31 (95% CI, 0.17–0.57) [22]
Additional LOS for nephrotoxicity, mean (days)	7 (95% CI, 5.7–8.4) [27]
Time required to determine clinical failure (days)	5 [Expert opinion]
Follow up period (weeks)	6 [Expert opinion]
Time to death for patients who had treatment success but died before 6-week follow-up, mean (weeks)	3.25 [8]
Time to death for patients who had treatment failure that died before 6-week follow-up, mean (weeks)	3.25 [8]
Average time to death during therapy (weeks)	1 [Expert opinion]
ICU LOS (days)^b
Success and then survival	7 [Expert opinion]
Success and then death	7 [Expert opinion]
Failure and then survival	14 [Expert opinion]
Failure and then death	14 [Expert opinion]
Other hospital LOS (days)^b
Success and then survival	23 [Expert opinion]
Success and then death	23 [Expert opinion]
Failure and death survival	23 [Expert opinion]
Failure and then death	23 [Expert opinion]
Cost (US$)
Loading dose cost
Fluconazole 400 mg/day	43.76 [28]
Anidulafungin 200 mg/day	164.48 [28]
Micafungin 100 mg/day	108.85 [28]
Caspofungin 70 mg/day	517.70 [28]
Liposomal amphotericin B 3 mg/kg for a patient with 76.4 kg ± 25.5 kg	962.61 [28]
Echinocandins	263.67^c [28]
Non-echinocandins	43.76^d [28]
Maintenance dose cost
Fluconazole 400 mg/day	43.76 [28]
Anidulafungin 100 mg/day	82.24 [28]
Micafungin 100 mg/day	108.85 [28]
Caspofungin 50 mg/day	258.85 [28]
Liposomal amphotericin B 3 mg/kg for a patient with 76.4 kg (± 25.5 kg)	962.61 [28]
Echinocandins	149.97^c [28]
Non-echinocandins	43.76^d [28]
ICU cost per day	203.39 [28]
Other hospital cost per day	43.27 [28]

Abbreviations: LOS length of hospital stay, ICU intensive care unit
^aTransformation of data from literature [7, 8]. Of note, because there appears to be no significant difference in the treatment success rate among the three echinocandins, we used the data (i.e., treatment success) for anidulafungin for C. albicans and non-albicans, respectively, in Reboli et al.’s study [8] for “echinocandins” for C. albicans and non-albicans. For example, Reboli et al.’s study [8] reported a success rate of anidulafungin treatment for C. albicans of 0.81 and Adnes et al.’s study [7] showed that the odds ratio for echinocandin treatment success as compared to that for non-echinocandins (including polyenes [amphotericin B and liposomal amphotericin B] and triazoles [fluconazole and voriconazole]) for C. albicans is 3.7, so the success rate of non-echinocandins was estimated to be 0.22. Similarly, Reboli et al.’s study [8] reported a success rate of anidulafungin treatment for non-albicans (including C. glabrate, C. parapsilosis, C. tropicalis, and other species) of 0.71 and Adnes et al.’s study [7] showed that the odds ratio for echinocandins treatment success as compared to that of non-echinocandins for non-albicans is 1, so the success rate of non-echinocandins for non-albicans was estimated to be 0.71. This transformation was also applied to estimate mortality rates for echinocandins and non-echinocandins for C. albicans and non-albicans, respectively
^bAccording to clinical practice in Taiwan [16, 17], experts assumed an average of 30 days for total length of hospital stay (LOS), of which 7 days are for stay in intensive care unit (ICU) and 23 days are for other hospital stay
^cAverage drug cost of echinocandins, including anidulafungin, micafungin, and caspofungin
^dThe cost of non-echinocandins refers to drug cost of fluconazole

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