Cost-utility analysis of caspofungin and fluconazole for primary treatment of invasive candidiasis and candidemia in Ethiopia
Abstract Background Invasive candidiasis and/or candidemia (IC/C) is a common fungal infection leading to significant health and economic losses worldwide. Caspofungin was shown to be more effective than fluconazole in treating inpatients with IC/C. However, cost-effectiveness of caspofungin for tre...
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| Format: | Article |
| Language: | English |
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BMC
2022-10-01
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| Series: | BMC Health Services Research |
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| Online Access: | https://doi.org/10.1186/s12913-022-08662-3 |
| _version_ | 1811192479756582912 |
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| author | Gebremedhin Beedemariam Gebretekle Atalay Mulu Fentie Girma Tekle Gebremariam Eskinder Eshetu Ali Daniel Asfaw Erku Tinsae Alemayehu Workeabeba Abebe Beate Sander |
| author_facet | Gebremedhin Beedemariam Gebretekle Atalay Mulu Fentie Girma Tekle Gebremariam Eskinder Eshetu Ali Daniel Asfaw Erku Tinsae Alemayehu Workeabeba Abebe Beate Sander |
| author_sort | Gebremedhin Beedemariam Gebretekle |
| collection | DOAJ |
| description | Abstract Background Invasive candidiasis and/or candidemia (IC/C) is a common fungal infection leading to significant health and economic losses worldwide. Caspofungin was shown to be more effective than fluconazole in treating inpatients with IC/C. However, cost-effectiveness of caspofungin for treating IC/C in Ethiopia remains unknown. We aimed to assess the cost-utility of caspofungin compared to fluconazole-initiated therapies as primary treatment of IC/C in Ethiopia. Methods A Markov cohort model was developed to compare the cost-utility of caspofungin versus fluconazole antifungal agents as first-line treatment for adult inpatients with IC/C from the Ethiopian health system perspective. Treatment outcome was categorized as either a clinical success or failure, with clinical failure being switched to a different antifungal medication. Liposomal amphotericin B (L-AmB) was used as a rescue agent for patients who had failed caspofungin treatment, while caspofungin or L-AmB were used for patients who had failed fluconazole treatment. Primary outcomes were expected quality-adjusted life years (QALYs), costs (US$2021), and the incremental cost-utility ratio (ICUR). These QALYs and costs were discounted at 3% annually. Cost data was obtained from Addis Ababa hospitals while locally unavailable data were derived from the literature. Cost-effectiveness was assessed against the recommended threshold of 50% of Ethiopia’s gross domestic product/capita (i.e.,US$476). Deterministic and probabilistic sensitivity analyses were conducted to assess the robustness of the findings. Results In the base-case analysis, treatment of IC/C with caspofungin as first-line treatment resulted in better health outcomes (12.86 QALYs) but higher costs (US$7,714) compared to fluconazole-initiated treatment followed by caspofungin (12.30 QALYs; US$3,217) or L-AmB (10.92 QALYs; US$2,781) as second-line treatment. Caspofungin as primary treatment for IC/C was not cost-effective when compared to fluconazole-initiated therapies. Fluconazole-initiated treatment followed by caspofungin was cost-effective for the treatment of IC/C compared to fluconazole with L-AmB as second-line treatment, at US$316/QALY gained. Our findings were sensitive to medication costs, drug effectiveness, infection recurrence, and infection-related mortality rates. At a cost-effectiveness threshold of US$476/QALY, treating IC/C patient with fluconazole-initiated treatment followed by caspofungin was more likely to be cost-effective in 67.2% of simulations. Conclusion Our study showed that the use of caspofungin as primary treatment for IC/C in Ethiopia was not cost-effective when compared with fluconazole-initiated treatment alternatives. The findings supported the use of fluconazole-initiated therapy with caspofungin as a second-line treatment for patients with IC/C in Ethiopia. |
| first_indexed | 2024-04-11T23:53:16Z |
| format | Article |
| id | doaj.art-b46207153d2d46ddb8f1829f35352958 |
| institution | Directory Open Access Journal |
| issn | 1472-6963 |
| language | English |
| last_indexed | 2024-04-11T23:53:16Z |
| publishDate | 2022-10-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Health Services Research |
| spelling | doaj.art-b46207153d2d46ddb8f1829f353529582022-12-22T03:56:26ZengBMCBMC Health Services Research1472-69632022-10-0122111010.1186/s12913-022-08662-3Cost-utility analysis of caspofungin and fluconazole for primary treatment of invasive candidiasis and candidemia in EthiopiaGebremedhin Beedemariam Gebretekle0Atalay Mulu Fentie1Girma Tekle Gebremariam2Eskinder Eshetu Ali3Daniel Asfaw Erku4Tinsae Alemayehu5Workeabeba Abebe6Beate Sander7Institute of Health Policy, Management and Evaluation, University of TorontoSchool of Pharmacy, Addis Ababa UniversitySchool of Pharmacy, Addis Ababa UniversitySchool of Pharmacy, Addis Ababa UniversityUniversity Centre for Applied Health Economics, School of Medicine & Menzies Health Institute Queensland, Griffith UniversityDepartment of Pediatrics and Child Health, St. Paul’s Hospital and Millennium Medical CollegeDepartment of Pediatrics and Child Health, School of Medicine, Addis Ababa UniversityInstitute of Health Policy, Management and Evaluation, University of TorontoAbstract Background Invasive candidiasis and/or candidemia (IC/C) is a common fungal infection leading to significant health and economic losses worldwide. Caspofungin was shown to be more effective than fluconazole in treating inpatients with IC/C. However, cost-effectiveness of caspofungin for treating IC/C in Ethiopia remains unknown. We aimed to assess the cost-utility of caspofungin compared to fluconazole-initiated therapies as primary treatment of IC/C in Ethiopia. Methods A Markov cohort model was developed to compare the cost-utility of caspofungin versus fluconazole antifungal agents as first-line treatment for adult inpatients with IC/C from the Ethiopian health system perspective. Treatment outcome was categorized as either a clinical success or failure, with clinical failure being switched to a different antifungal medication. Liposomal amphotericin B (L-AmB) was used as a rescue agent for patients who had failed caspofungin treatment, while caspofungin or L-AmB were used for patients who had failed fluconazole treatment. Primary outcomes were expected quality-adjusted life years (QALYs), costs (US$2021), and the incremental cost-utility ratio (ICUR). These QALYs and costs were discounted at 3% annually. Cost data was obtained from Addis Ababa hospitals while locally unavailable data were derived from the literature. Cost-effectiveness was assessed against the recommended threshold of 50% of Ethiopia’s gross domestic product/capita (i.e.,US$476). Deterministic and probabilistic sensitivity analyses were conducted to assess the robustness of the findings. Results In the base-case analysis, treatment of IC/C with caspofungin as first-line treatment resulted in better health outcomes (12.86 QALYs) but higher costs (US$7,714) compared to fluconazole-initiated treatment followed by caspofungin (12.30 QALYs; US$3,217) or L-AmB (10.92 QALYs; US$2,781) as second-line treatment. Caspofungin as primary treatment for IC/C was not cost-effective when compared to fluconazole-initiated therapies. Fluconazole-initiated treatment followed by caspofungin was cost-effective for the treatment of IC/C compared to fluconazole with L-AmB as second-line treatment, at US$316/QALY gained. Our findings were sensitive to medication costs, drug effectiveness, infection recurrence, and infection-related mortality rates. At a cost-effectiveness threshold of US$476/QALY, treating IC/C patient with fluconazole-initiated treatment followed by caspofungin was more likely to be cost-effective in 67.2% of simulations. Conclusion Our study showed that the use of caspofungin as primary treatment for IC/C in Ethiopia was not cost-effective when compared with fluconazole-initiated treatment alternatives. The findings supported the use of fluconazole-initiated therapy with caspofungin as a second-line treatment for patients with IC/C in Ethiopia.https://doi.org/10.1186/s12913-022-08662-3CandidemiaCaspofunginEchinocandinFluconazoleInvasive candidiasisCost-effectiveness |
| spellingShingle | Gebremedhin Beedemariam Gebretekle Atalay Mulu Fentie Girma Tekle Gebremariam Eskinder Eshetu Ali Daniel Asfaw Erku Tinsae Alemayehu Workeabeba Abebe Beate Sander Cost-utility analysis of caspofungin and fluconazole for primary treatment of invasive candidiasis and candidemia in Ethiopia BMC Health Services Research Candidemia Caspofungin Echinocandin Fluconazole Invasive candidiasis Cost-effectiveness |
| title | Cost-utility analysis of caspofungin and fluconazole for primary treatment of invasive candidiasis and candidemia in Ethiopia |
| title_full | Cost-utility analysis of caspofungin and fluconazole for primary treatment of invasive candidiasis and candidemia in Ethiopia |
| title_fullStr | Cost-utility analysis of caspofungin and fluconazole for primary treatment of invasive candidiasis and candidemia in Ethiopia |
| title_full_unstemmed | Cost-utility analysis of caspofungin and fluconazole for primary treatment of invasive candidiasis and candidemia in Ethiopia |
| title_short | Cost-utility analysis of caspofungin and fluconazole for primary treatment of invasive candidiasis and candidemia in Ethiopia |
| title_sort | cost utility analysis of caspofungin and fluconazole for primary treatment of invasive candidiasis and candidemia in ethiopia |
| topic | Candidemia Caspofungin Echinocandin Fluconazole Invasive candidiasis Cost-effectiveness |
| url | https://doi.org/10.1186/s12913-022-08662-3 |
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