Presentation (CTI)

OBJECTIVES: Invasive candidiasis, including candidemia and deep-seated Candida infections, is associated with prolonged hospitalization, frequent ICU admission, and high mortality. Brazil incidence rates exceed those of high-income countries, intensifying clinical and economic burden. While echinocandins are recommended as first-line therapy, their need for daily intravenous dosing may prolong ICU stay and delay transitions of care. Rezafungin is a next generation echinocandin with a differentiated PK/PD profile and extended half-life, enabling front-loaded, once-weekly dosing and has shown non-inferior efficacy to daily agents. This analysis aims to assess ICU-related resource use and the number of antifungal infusions over a 28-day treatment horizon in adults with IC or candidemia requiring ICU admission, comparing rezafungin with daily echinocandins from the Brazilian supplementary health system perspective.
METHODS: This exploratory analysis used pooled data from two randomised clinical trials (NCT03667690, NCT02734862) which evaluated ICU and hospital length of stay among patients with IC treated with rezafungin or caspofungin (Honoré et al. 2024). Outcomes were extrapolated to all echinocandins based on therapeutic equivalence. ICU daily costs were estimated through micro-costing, including physician visits, consumables, supportive medications, and hospitalization fees. Drug acquisition costs were excluded. Total infusions were calculated from approved dosing schedules.
RESULTS: Rezafungin was associated with a mean ICU stay of 17.3 days compared with 21.4 days for daily echinocandins, a reduction of 4.1 days. With an ICU daily cost of R$ 2,894.69, this reduction translates to potential savings of R$ 11,868.25 per patient. Across the 28-day horizon, rezafungin required only 5 infusions versus 28-29 infusions for standard echinocandins, demonstrating substantially lower infusion burden.
CONCLUSIONS: From the Brazilian supplementary payer perspective, rezafungin may significantly reduce ICU bed-days and infusion-related resource use in IC and candidemia, generating meaningful per-patient savings. Given comparable clinical efficacy across echinocandins, once-weekly rezafungin may support more efficient ICU resource allocation and inform decision-making in resource-constrained settings.