Cost-effectiveness analysis of caspofungin for empirical treatment of candidemia in patients after cardiac surgery

Abstract

Candidemia is the fourth most common cause of bloodstream infection in tertiary hospitals in the U.S. and Brazil. The risk factors for the development of candidemia are prolonged hospitalization, exposure to multiple invasive procedures, antibiotic therapy. Despite the proven efficacy, the cost of therapy with caspofungin doses and dosing regimens is about 90 times higher than with fluconazole. Objective: To determine cost-effectiveness of caspofungin compared to fluconazole for empirical treatment of candidemia in patients after cardiac surgery, from the perspective of the Brasilian Public Healthcare System. Methods: Using a software was constructed a decision analytic model. Data entered into the model were obtained from the literature review. The model considers the mean direct cost of administering the drug, hospitalization and laboratory tests of SUS. The clinical outcomes used to evaluate the efficacy was death attributed to candidemia. Results: Treatment costs attributed to caspofungin was R$117,578.86 and fluconazole was R$65,543.84. According to the Tornado Diagram made the biggest impact of variables in the model were likely to improve with fluconazole, given death improves with fluconazole, caspofungin and improves with death as no improvement with fluconazole. In the sensitivity analysis, simulations performed with modifications of these variables showed no significant influence on the initial result. Conclusion: fluconazole was more cost effective than caspofungin for empirical treatment of Candidemia in patients after cardiac surgery.