Universidade do Estado do Rio de Janeiro, Instituto de Medicina Social, Departamento de Política, Planejamento e Administração em Saúde, Rio de Janeiro, Rio de Janeiro, Brazil.
Universidade Federal Fluminense, Instituto de Saúde Coletiva, Departamento de Saúde e Sociedade, Niterói, Rio de Janeiro, Brazil.
Rev Inst Med Trop Sao Paulo. 2023 Jan 30;65:e9. doi: 10.1590/S1678-9946202365009. eCollection 2023.
Candidemia and other forms of invasive candidiasis (C/IC) are serious conditions, especially for immunosuppressed individuals with prolonged hospitalization in intensive care units (ICU). This study analyzed the incremental cost-effectiveness and budgetary impact (BI) of treatment for IC with anidulafungin compared to amphotericin B lipid complex (ABLC) and amphotericin B deoxycholate (ABD) or conventional amphotericin B (CAB), in the Brazilian Unified Health System (SUS). A decision model was conducted with a time horizon of two weeks from the perspective of SUS. The primary effectiveness endpoints were survival and treatment response rate. All patients were followed up until successful therapy or death. BI analysis was performed based on the measured demand method. A five-year time horizon was adopted based on the number of hospitalizations (per 1,000 hospitalizations). For effectiveness measured in the successful response rate (SRR), anidulafungin dominated the ABLC and ABD formulations. In the results of the analysis with the effectiveness measured according to survival, anidulafungin had a better cost-effectiveness ratio (R$988.26/survival) compared to ABD (R$16,359.50/survival). The BI estimate related to the incorporation of anidulafungin suggests savings of approximately 148 million reais in 5 years when comparing it to ABD. The economic evaluation of anidulafungin and its comparators found it to be cost-effective. The consensus of international scientific societies recommends it as a first-line drug for IC, and its incorporation by SUS would be important.
念珠菌血症和其他形式的侵袭性念珠菌病（C/IC）是严重的疾病，特别是对于在重症监护病房（ICU）住院时间延长的免疫功能低下个体。本研究分析了与两性霉素 B 脂质复合物（ABLC）和两性霉素 B 去氧胆酸盐（ABD）或常规两性霉素 B（CAB）相比，棘白菌素治疗 C/IC 的增量成本效益和预算影响（BI）在巴西统一卫生系统（SUS）中。从 SUS 的角度来看，使用了一个两周的时间范围来进行决策模型。主要有效性终点是生存和治疗反应率。所有患者均随访至成功治疗或死亡。BI 分析基于测量的需求方法进行。根据住院次数（每 1000 次住院），采用了五年的时间范围。对于以成功反应率（SRR）衡量的有效性，棘白菌素优于 ABLC 和 ABD 制剂。在根据生存情况衡量的分析结果中，与 ABD（生存成本效益比为 R$16,359.50/生存）相比，棘白菌素具有更好的成本效益比（R$988.26/生存）。与 ABD 相比，纳入棘白菌素的 BI 估计表明，在 5 年内可节省约 1.48 亿雷亚尔。棘白菌素及其对照药物的经济评估发现其具有成本效益。国际科学协会的共识建议将其作为 C/IC 的一线药物，SUS 的采用将非常重要。
