Cost-Effectiveness of Once-Weekly Rezafungin for the Treatment of Candidemia and Invasive Candidiasis in the UK
Muszbek N1, Angdembe A1, Garcia-Vidal C2, Bielicka I3, Abrams K1, Tolley K4, Ruhnke M5, Lebmeier M3, Hawkins N1, Manamley N3, Dickerson S3
1Visible Analytics, Oxford, Oxfordshire, UK, 2Hospital Clínic de Barcelona, Barcelona, Catalonia, Spain, 3Mundipharma Research Ltd, Cambridge, Cambridgeshire, UK, 4Tolley Health Economics, Buxton, DBY, UK, 5Helios Klinikum Aue, Aue-Bad Schlema, Sachsen, Germany
OBJECTIVES: Candidemia and invasive candidiasis (C/IC), serious, life-threatening fungal infections with high economic burden, are often treated first-line with daily intravenous echinocandins. A new once weekly echinocandin, rezafungin demonstrated statistically non-inferior efficacy and numerically shorter intensive care unit (ICU) stay compared to caspofungin in phase 2 and 3 trials, with potential for earlier discharge. This study assessed the cost-effectiveness of rezafungin versus daily echinocandins for the treatment of C/IC from UK healthcare perspective.
METHODS: Hybrid model was developed including a short-term decision tree (capturing treatment duration ≤30 days) and a long-term Markov model (capturing lifetime outcomes). Trial data, network meta-analyses, and clinical experts suggested similar efficacy for all echinocandins, therefore cost-minimisation analysis was performed as base case and cost-utility analysis as scenario analysis. Treatment response was assessed at days 5 and 14. Non-responders were assumed to switch to second-line treatment. Patients with negative repeat blood cultures could step down to oral fluconazole. Weekly rezafungin administration could allow early discharge for 16% of all patients. Risk of death was included. Efficacy and resource use estimates were from pooled trial data, assuming equal efficacy/resource use for daily echinocandins. Unit costs, utilities, long-term mortality were from published literature and public UK databases. Annual discount rate was 3.5%. Conceptual/technical validation, probabilistic and deterministic sensitivity analyses were conducted.
RESULTS: Rezafungin was cost-saving compared to daily echinocandins (discounted incremental costs: -£7,789, -£8,344 and -£8,705 vs. caspofungin, micafungin and anidulafungin respectively). In scenario analysis, quality-adjusted life-years (QALYs) were similar (incremental QALY: -0.03 vs. all comparators), resulting in rezafungin being cost-effective (net monetary benefit with £20,000/QALY threshold: £7,154-£8,069 vs. daily echinocandins). Results were most sensitive to ICU length of stay and treatment response (day 14).
CONCLUSIONS: Once weekly rezafungin is a cost-saving and cost-effective treatment option in C/IC from the UK healthcare perspective compared to currently available options.
Conference/Value in Health Info
Value in Health, Volume 26, Issue 11, S2 (December 2023)
Cost-comparison, Effectiveness, Utility, Benefit Analysis
Infectious Disease (non-vaccine)