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Background. Micafungin has demonstrated efficacy against invasive Candida infections in a range of patients, including those in the intensive care unit (ICU). Phase 3 studies demonstrated that micafungin was non-inferior to caspofungin for the treatment of invasive candidasis/candidaemia (Pappas 2007). In France, micafungin is currently used less often than caspofungin; therefore this analysis considered the budget impact of increased use of micafungin in the treatment of ICU patients in France.
Methods. A decision-tree model was developed to compare the costs associated with proposed and current prescribing patterns in French ICU patients, over 16 years of age, with confirmed invasive candidasis/candidaemia. The time horizon of the analysis was 19 days. Patients entered the model and received treatment with either micafungin or caspofungin. After 10 days of treatment, patients with confirmed susceptibility were switched to fluconazole for the remaining 4 days of treatment; patients with resistant isolates continued to receive echinocandin therapy. Patients in whom echinocandin treatment was not successful were switched to L-AmB after 5 days. All inputs related to prescribing and costs were from French published sources and were user-changeable. Epidemiological and mortality data were sourced from targeted literature searches carried out in January 2015. Comparative efficacy was sourced from an indirect treatment comparison.
Results. Based on clinical trial evidence, the model estimated that an additional 12 and 6 patients need to be treated with micafungin to obtain an additional clinical cure and mycological cure, respectively. The average costs per patient treated with micafungin and with caspofungin were estimated to be €34,933 and €36,785, respectively. Assuming a current market share of 4% with micafungin and 19% with caspofungin; the cumulative budget impact of increasing micafungin use by 4% in year 1 and 1% for 4 years thereafter was −€2,057.
Conclusion. Micafungin represents a potentially cost saving treatment for adult ICU patients with confirmed invasive candidasis/candidaemia in France.
Disclosures. M. Watt, Astellas: Employee, Salary; N. Trevor, NCT: Consultant, Consulting fee; P. Brennan-Benson, Astellsa: Employee, Salary; I. Odeyemi, Astellsa: Employee, Salary
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