ABSTRACT
OBJECTIVE: To analyze the cost-effectiveness of weekly somatrogon compared to daily growth hormones (GH-d) in the pediatric population of Spain with growth hormone deficiency (GHD). METHODS: Markov model with two states (patients with or without GH-d or somatrogon treatment) in prepubertal children (3 to 11 years and 3 to 12 years in girls and boys, respectively) with GHD in isolation or as part of multiple pituitary hormone deficiency and without previous treatment, from the perspective of the National Health System. The simulation of the economic model ends at the age of 18. The costs of hormones and monitoring were obtained from Spanish sources. The utilities were obtained from the literature. Spanish clinical experts validated the assumptions of the model. RESULTS: In the deterministic analysis, somatrogon would be cost-effective, compared to GH-d, with a cost per QALY (quality-adjusted life year) gained of 19,259 and a clinically relevant QALY gain (0.336). This result was confirmed in deterministic sensitivity analyses. According to the probabilistic analysis, somatrogon would be the dominant treatment, with a 61% probability of a willingness to pay of 25,000 per QALY gained. CONCLUSION: Compared to GH-d, somatrogon is cost-effective in the Spanish pediatric population with GHD.
Subject(s)
Growth Hormone , Models, Economic , Male , Female , Humans , Child , Cost-Benefit Analysis , Spain , Quality-Adjusted Life YearsABSTRACT
OBJECTIVE: To estimate the cost-effectiveness of three echinocandins (anidulafungin, caspofungin, and micafungin) and generic fluconazole in the treatment of nonneutropenic adult patients with candidemia and/or invasive candidiasis in intensive care units in Spain. MATERIALS AND METHODS: A decision-tree model was applied. The success and safety (hepatic and renal adverse effects) of first-line treatments were obtained from meta-analyses and systematic reviews of clinical trials. In the case of failure, a second-line treatment (liposomal amphotericin B after the echinocandins, or one of the echinocandins after fluconazole) was administered. The duration of the treatments (14 days total) was established by a panel of clinical experts using the Delphi method and according to Infectious Diseases Society of America guidelines. The cost of the medications and renal toxicity were considered. Deterministic and probabilistic sensitivity analysis using Monte Carlo simulations were carried out. RESULTS: The total cost of the treatment of candidemia and/or invasive candidiasis with anidulafungin, caspofungin, micafungin, and fluconazole was 5,483, 5,968, 6,231, and 2,088, respectively. Anidulafungin was the dominant treatment (more effective, less expensive) compared to micafungin and caspofungin. The cost of achieving one more patient successfully treated with anidulafungin, caspofungin, and micafungin compared to fluconazole was 17,199, 23,962, and 27,339, respectively. The result remained stable, despite modification of the duration of the first-line and second-line treatments, as well as most of the dosing regimens. The probabilistic analysis also remained stable. CONCLUSION: In accordance with this economic study, anidulafungin would produce savings and would be the dominant treatment compared with micafungin and caspofungin in nonneutropenic adult patients with candidemia and/or invasive candidiasis in intensive care units in Spain.
ABSTRACT
BACKGROUND: Candidaemia and invasive Candida infections can cause patient death and are expensive. Anidulafungin, a newly-licensed candin, has proven effective in treating candidaemia. Our study evaluates the cost-effectiveness of anidulafungin compared with fluconazole, the current standard of care, for treating invasive candidiasis and candidaemia in Spain. METHODS: A decision tree model from the hospital perspective was constructed to examine the cost-effectiveness of anidulafungin compared with fluconazole in treating confirmed candidaemia. Treatment success, patient treatment patterns, and patient survival were based on the results from a randomised, double-blind multicentre trial (Reboli et al., 2007 [41]). Only in-hospital (2011 ) direct costs per-patient obtained from a Spanish national database were considered. Renal toxicity probabilities and costs were extracted from the published literature. The incremental cost per successfully treated patient was calculated. One-way sensitivity analyses were performed to test model robustness. RESULTS: The percentage of successfully treated patients was higher with anidulafungin than with fluconazole (74% versus 57%). Treatment with anidulafungin resulted in higher antifungal drug costs (5991 versus 3149) but lower overall costs (40047 versus 41350) due to reductions in other medical costs. Univariate sensitivity analyses showed that anidulafungin was the most cost-effective. CONCLUSIONS: Anidulafungin demonstrated improved clinical efficacy versus fluconazole in treating confirmed candidaemia. Despite increased drug costs, treating confirmed candidaemia with anidulafungin is a cost-effective strategy.
Subject(s)
Candidemia/drug therapy , Candidiasis, Invasive/drug therapy , Echinocandins/economics , Echinocandins/therapeutic use , Anidulafungin , Antifungal Agents/economics , Antifungal Agents/therapeutic use , Candidemia/economics , Candidemia/epidemiology , Candidiasis, Invasive/economics , Candidiasis, Invasive/epidemiology , Cost-Benefit Analysis , Health Care Costs , Humans , Multicenter Studies as Topic/economics , Multicenter Studies as Topic/statistics & numerical data , Randomized Controlled Trials as Topic/economics , Randomized Controlled Trials as Topic/statistics & numerical data , Spain/epidemiologyABSTRACT
Objetivo: Estimar el coste de tres candinas (anidulafungina, caspofungina, y micafungina) en el tratamiento de pacientes adultos no neutropénicos con candidiasis invasora (CI), desde la perspectiva de la Farmacia Hospitalaria en España. Métodos Para evaluar el impacto global en los costes, se han considerado diferentes escenarios posibles modificando el porcentaje de ajuste de dosis requerido con cada candina. Los precios de cada presentación (€, agosto 2010), se han obtenido del Catálogo de Medicamentos. Únicamente se han considerado los costes de adquisición del fármaco. Los resultados se expresan como coste total para cada una de las tres candinas. Resultados El coste por episodio (14días de tratamiento) de anidulafungina por paciente se mantiene constante en 5.400€. El coste de casponfungina varía de 4.281€ a 7.991€, dependiendo del peso del paciente y la disfunción hepática. El coste de micafungina osciló entre 6.000€ (100mg/día) y 9.000€ (aumento de dosis por respuesta inadecuada al tratamiento). El coste total de tratar a una hipotética cohorte de 100 pacientes con CI con anidulafungina sería de 540.000€, mientras que con caspofungina y micafungina sería de 631.459€ y 632.998€, respectivamente, dependiendo del ajuste de dosis requerido. Conclusión Los pacientes tratados con anidulafungina no requieren ajuste de la dosis, a diferencia de caspofungina y micafungina. El empleo de anidulafungina en el tratamiento de la CI en pacientes adultos no neutropénicos es una opción que conlleva un ahorro de costes, lo que permite un mejor control del presupuesto desde la perspectiva de la Farmacia Hospitalaria en España (AU)
Objective: To estimate the cost of 3 candins (anidulafungin, caspofungin and micafungin) inthe treatment of adult non-neutropaenic patients with invasive candidiasis (IC) in a Spanish hospital pharmacy setting. Methods: The overall cost impact was evaluated by varying the percentage dosage required of each candin in different possible scenarios. The prices (in euros) for each presentation wereobtained from the Drug Catalogue (in August 2010). Only drug purchase costs were considered. The results are expressed as total cost for each of the 3 candins. Results: The cost per episode (14 days) of anidulafungin was constant at D 5400 per patient. The cost of caspofungin varied from € 4281 to € 7991, depending on patient weight and liverdysfunction. The cost of micafungin varied from € 6000 (100 mg/day) to € 9000 (when increasing the dose due to inadequate response). Based on a hypothetic cohort of 100 patients with IC, the total cost of anidulafungin treatment would be € 540 000, for caspofungin it would be € 631 459,and for micafungin it would be € 632 998, depending on any dose adjustment required. Conclusion: Patients treated with anidulafungin did not require dose adjustment, unlike those treated with caspofungin or micafungin. The use of anidulafungin is a cost-saving treatment for adult non-neutropaenic patients with IC, which would result in better control of the Spanish pharmacy budget (AU)
Subject(s)
Humans , Candidemia/drug therapy , Antifungal Agents/therapeutic use , Drug Costs/statistics & numerical data , Candida/pathogenicityABSTRACT
OBJECTIVE: To estimate the cost of 3 candins (anidulafungin, caspofungin and micafungin) in the treatment of adult non-neutropaenic patients with invasive candidiasis (IC) in a Spanish hospital pharmacy setting. METHODS: The overall cost impact was evaluated by varying the percentage dosage required of each candin in different possible scenarios. The prices (in euros) for each presentation were obtained from the Drug Catalogue (in August 2010). Only drug purchase costs were considered. The results are expressed as total cost for each of the 3 candins. RESULTS: The cost per episode (14 days) of anidulafungin was constant at 5400 per patient. The cost of caspofungin varied from 4281 to 7991, depending on patient weight and liver dysfunction. The cost of micafungin varied from 6000 (100mg/day) to 9000 (when increasing the dose due to inadequate response). Based on a hypothetic cohort of 100 patients with IC, the total cost of anidulafungin treatment would be 540,000, for caspofungin it would be 631,459, and for micafungin it would be 632,998, depending on any dose adjustment required. CONCLUSION: Patients treated with anidulafungin did not require dose adjustment, unlike those treated with caspofungin or micafungin. The use of anidulafungin is a cost-saving treatment for adult non-neutropaenic patients with IC, which would result in better control of the Spanish pharmacy budget.
