Cost-effectiveness of micafungin as an alternative to fluconazole empiric treatment of suspected intensive care unit-acquired candidemia among patients with sepsis: a model simulation
IntroductionRecent epidemiologic literature indicates that candidal species resistant to azoles are becoming more prevalent in the face of increasing incidence of hospitalizations with candidemia. Echinocandins, a new class of antifungal agents, are effective against resistant candidal species.
Since delaying appropriate antifungal coverage leads to increased mortality, we evaluated cost-effectiveness of 100 mg daily empiric micafungin (MIC) vs. 400 mg daily fluconazole (FLU) for suspected intensive care unit-acquired candidemia (ICU-AC) among septic patients.
Methods: We designed a decision model with inputs from the literature in a hypothetical 1,000-patient cohort with suspected ICU-AC treated empirically with either MIC or FLU or no treatment accompanied by watchful waiting strategy.
We examined the differences in the number of survivors, acquisition costs of antifungals, and lifetime costs among survivors in the cohort under each scenario, and calculated cost per quality adjusted life year (QALY). We conducted Monte Carlo simulations and sensitivity analyses to determine the stability of our estimates.
Results: In the base case analysis, assuming ICU-AC attributable mortality of 0.40 and a 52% relative risk reduction in mortality with appropriate timely therapy, compared to FLU (total deaths 31), treatment with MIC (total deaths 27) would result in 4 fewer deaths at an incremental cost/death averted of $61,446.
Similarly, in reference case, incremental cost effectiveness of MIC over FLU was $34,734 (95% confidence interval $26,312 to $49,209) per QALY. The estimates were most sensitive to the QALY adjustment factor and the risk of candidemia among septic patients.
Conclusions: Given the increasing likelihood of azole resistance among candidal isolates, empiric treatment of ICU-AC with 100 mg daily MIC is a cost effective alternative to FLU.
Author: Marya ZilberbergSmita KothariAndrew Shorr
Credits/Source: Critical Care 2009, 13:R94
Published on: 2009-06-19
Copyright by the authors listed above - made available via BioMedCentral (Open Access). Please
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