OBJECTIVES: To evaluate the cost-effectiveness of micafungin versus liposomal amphotericin B (L-AMB) for first-line treatment of invasive candidiasis and candidaemia in paediatric patients in the intensive care unit (ICU) setting. METHODS: The economic model, designed to simulate a 2-week disease-management period from the perspective of the UK National Health Service, used data from a paediatric sub-study of a larger, double-blind, randomised trial of micafungin (2 mg/kg) versus L-AMB (3 mg/kg). Clinical outcomes included treatment success rates, mortality, treatment duration, dosing, discontinuations, and adverse events (AEs). Medical costs included acquisition of study drugs, treating drug-related AEs, and hospital length of stays. RESULTS: Overall treatment success rates were similar, 73% (35/48) and 76% (38/50) in the micafungin and L-AMB arms, respectively; discontinuation rates owing to AEs were lower with micafungin, 4% (2/52) compared to 17% (9/54), for L-AMB. Average treatment costs were lower (£19,573) in the micafungin versus L-AMB (£22,931) groups; the vast majority of these costs were associated with hospitalisation (£18,466 and £22,073, respectively), driven by difference in ICU stay. Sensitivity analyses showed the results were robustly consistent over a wide range of variables but sensitive to length and cost of stay in a paediatric ICU and probability of survival. CONCLUSIONS: Micafungin is a cost-effective treatment option compared to L-AMB in the management of invasive candidaemia and candidiasis in paediatric patients