OBJECTIVES: Direct and indirect costs caused by candidemia in ICU patients are currently unknown. We performed an analysis comparing costs depending on the type of antifungal treatment. METHODS: Data of patients from the University Hospital of Cologne with at least one blood culture positive for Candidaspp. while staying on the ICU between 2005 and 2010 were documented into a database. Indirect costs caused by illness-conditioned disability and death before retirement age were calculated using the friction cost method. Analysis was split for patients treated with new antifungals (i.e. echinocandins, liposomal amphotericin B, or voriconazole) or conventional antifungals (i.e. amphotericin B deoxycholate or fluconazole). RESULTS: Out of 147 identified patients, 45 received new and 66 conventional antifungals, and 36 patients were excluded from analysis (21 died within 96 hours after positive blood culture, seven were rated as contamination, eight patient files were missing). Mean APACHE IV score was 113 (105.7-121.2) vs. 96 (90.3-100.8, P=<0,001). Mean direct costs per patient in the new and the conventional antifungal groups were as follows: ICU treatment 24,922 € (95% CI: 17,054-31,789 €) vs. 17,971 € (95% CI: 13,203-22,740 €,P=n.s.), antifungal treatment 4,271 € (95% CI: 2,983-5,560 €) vs. 2,079 € (95% CI: 1,246-2,912€, P=0.005), total direct costs 41,060 € (95% CI: 30,184-51,935 €) vs. 28,885 € (95% CI: 22,116-35,654 €, n.s.), indirect costs per patient due to productivity loss of illness-related disability 1,202 € (95% CI: 474-1,930 €) vs. 1,087 € (95% CI: 570-1,604 €, n.s.), due to death before retirement age 1,047 € (95% CI: 236-1,858 €) vs. 1,309 € (95% CI: 584-2,034 €, n.s.). Twenty-five (56%) and 33 (50%) patients survived hospitalization, 20 (44%) and 22 (33%) patients survived one year after diagnosis. CONCLUSIONS: Our cost-of-illness analysis shows the high treatment costs of patients with candidemia. In our analysis, treatment with new antifungals was associated with higher costs. Although sicker patients were significantly more likely to receive new antifungals, outcomes were comparable to less sick patients treated with conventional antifungals