OBJECTIVES: To evaluate the cost-effectiveness of micafungin compared to caspofungin in the treatment of systemic Candida infections (SCIs) in Italy, including invasive candidiasis and candidaemia. METHODS: Cost-effectiveness of both echinocandin antifungal drugs was estimated using decision analysis. Response to treatment, resource utilisation, and costs in the model were derived from a phase 3, head-to-head comparative trial. The model includes only data directly related to the treatment of the systemic Candida infection over the study duration (a maximum period of 14 weeks). Transition probabilities were calculated based on the efficacy results from the clinical trial. The model’s effectiveness outcome is surviving patients who are successfully treated, based on the absence of signs and symptoms, radiographic abnormalities, and culture/histologic evidence associated with the fungal infection. In addition, subgroup analyses were performed to identify cost-effectiveness in several specific patient groups. RESULTS: The total medical treatment costs for the micafungin group were €30,758 , which is similar to the total costs for the caspofungin group (€31,923). In the micafungin arm 60% of the patients and in the caspofungin arm 58% of the patients were successfully treated and alive. Cost-effectiveness ratio of micafungin was €51,558, and of caspofungin €55,489 per successfully treated patient. Because the costs are lower and the effectiveness is higher for micafungin in comparison with caspofungin, micafungin is more cost-effective than caspofungin.  Probabilistic sensitivity and subgroup analysis show that although the difference cannot be considered significant, due to a large variance, micafungin was the most cost-effective option in all subgroup analyses except one. CONCLUSIONS: Costs and effects of micafungin compare favourably to those of caspofungin in the treatment of systemic Candida infections in Italy. Sensitivity analysis showed that despite the uncertainty in cost‑effectiveness ratio this result is robust. Subgroup analyses showed similar results.