Collaborative Drug Discovery Research (CDDR) Group, Faculty of Pharmacy, Universiti Teknologi MARA, 42300, Puncak Alam, Selangor, Malaysia.
Department of Infectious Diseases, Gazi University, Ankara, Turkey.
Eur J Clin Microbiol Infect Dis. 2018 Mar;37(3):537-544. doi: 10.1007/s10096-017-3147-9. Epub 2017 Nov 28.
Micafungin was shown to be as efficacious as caspofungin in treating patients with candidaemia and invasive candidiasis (IC). However, it remains unknown if micafungin or caspofungin is a cost-effective definitive therapy for candidaemia and IC in Turkey. The present study aimed to determine the economic impact of using micafungin versus caspofungin for treatment of candidaemia and IC in the Turkish setting. A decision analytic model was constructed and was populated with data (i.e. transition probabilities, duration of initial antifungal treatment, reasons for treatment failure, percentage of patients who stepped down to oral fluconazole, and duration on oral fluconazole) obtained from a published randomised clinical trial. Cost inputs were derived from the latest Turkish resources while data that were not readily available in the literature were estimated by expert panels. One-way sensitivity analyses, threshold analyses, scenario analyses and probabilistic sensitivity analyses were conducted. Caspofungin (€2693) incurred a lower total cost than micafungin (€4422), with a net cost saving of €1729 per treated patient. Drug acquisition cost was the main cost driver for both study arms. The model outcome was robust over wide variations (of ±100.0% from the base case value) for all input parameters except for micafungin drug cost and the duration of initial treatment with micafungin. Caspofungin appears to be a cost-saving option in treating candidaemia and IC from the Turkish hospital perspective.
米卡芬净在治疗念珠菌血症和侵袭性念珠菌病（IC）患者方面的疗效与卡泊芬净相当。然而，在土耳其，米卡芬净或卡泊芬净是否是念珠菌血症和 IC 的一种具有成本效益的确定性治疗方法尚不清楚。本研究旨在确定在土耳其使用米卡芬净与卡泊芬净治疗念珠菌血症和 IC 的经济影响。构建了一个决策分析模型，并使用来自已发表的随机临床试验的数据（即转换概率、初始抗真菌治疗持续时间、治疗失败的原因、转为口服氟康唑的患者比例以及口服氟康唑的持续时间）进行填充。成本投入来自最新的土耳其资源，而文献中不易获得的数据则由专家小组进行估算。进行了单因素敏感性分析、阈值分析、情景分析和概率敏感性分析。卡泊芬净（€2693）的总成本低于米卡芬净（€4422），每个治疗患者的净成本节省为€1729。药物获取成本是两个研究组的主要成本驱动因素。除了米卡芬净药物成本和米卡芬净初始治疗持续时间外，模型结果在所有输入参数的±100.0%范围内都具有稳健性。从土耳其医院的角度来看，卡泊芬净似乎是治疗念珠菌血症和 IC 的一种节省成本的选择。
