OBJECTIVES: To estimate the cost-effectiveness (CE) of the 3 echinocandins (Anidulafungin, Caspofungin and Micafungin) and generic Fluconazole in the treatment of adult non-neutropaenic patients with invasive candidiasis (IC) in a Spanish Intensive Care Unit (ICU) setting. METHODS: A 4 arm decision tree model was developed with the 3 echinocandins and generic Fluconazole as first line treatment. In case of treatment failure, a 2nd line treatment was administered (Liposomal Amphotericin-B  following the echinocandins and either one of the 3 echinocandins for Fluconazole arm). After 2nd line failure, treatment was discontinued. Total treatment length was 14 days. Efficacy and safety (adverse events/lack of efficacy) parameters where obtained from a mixed-treatment-comparison and a meta-analysis respectively. Efficacy was considered as first line success (Anidulafungin 75.32%; Micafungin 71.65%; Caspofungin 70.62%; and Fluconazole 56.7%). Length of the first and the second line were elicited using experts´ opinion through Delphi methodology. Daily drug acquisition costs were considered only. The CE was expressed as an incremental cost-effectiveness ratio (ICER). Univariate sensitivity analyses were also applied and included, length of treatment in 1st or 2nd line and finally drug dosages calculated as per SmPC recommendations according to different patient characteristics. RESULTS: Total costs of IC treatment for Anidulafungin, Micafungin, Caspofungin and Fluconazole were €5,552; €5,985; €6,350; €1,654 respectively. Anidulafungin was dominant compared to Micafungin and Caspofungin. Anidulafungin and Micafungin were cost-effective (€20,934; 29.576€ respectively) compared to Fluconazole (CE threshold of €30,000). Sensitivity analyses revealed that ICER was sensitive to increases in the length of the 1st and 2nd line treatments, although Anidulafungin was cost-effective in all scenarios.  CONCLUSIONS: Based on the model’s assumptions, Anidulafungin is cost-saving compared to Micafungin and Caspofungin and cost-effective vs. Fluconazole in the treatment of patients with confirmed invasive candidiasis from a Spanish Hospital ICU perspective.