OBJECTIVES: Candidemia or invasive candidiasis is a nosocomial infection associated with considerable mortality and with substantial economic impact due to its long hospital length of stay. The role of appropriate initial antifungal agent is crucial for improved outcomes and reduced hospital costs. This study evaluated the cost-effectiveness of anidulafungin as a new echinocandin, by comparing anidulafungin with fluconazole in the treatment of candidemia or invasive candidiasis. METHODS: A decision analytic model was developed, from the Korean health care system perspective, to examine the cost-effectiveness of anidulafungin compared with fluconazole. Efficacy data on treatment success, renal toxicity, and survival were obtained from the clinical trial study which compared anidulafungin with fluconazole (Reboli, 2007). Drug cost and other medical cost were derived from a cost of illness study of candidemia in Korea. Average cost-effectiveness and incremental cost-effectiveness of each drug per survival patient were calculated. RESULTS: The overall survival rate was higher for patients treated with anidulafungin than with fluconazole (77.17% vs. 68.64%). The total costs were 6,929,620 KRW for anidulafungin and 6,629,357 KRW for fluconazole. However, because of the better clinical efficacy, the average cost-effectiveness per survival patient was lower for the anidulafungin treatment than fluconazole treatment (8,980,222 KRW vs. 9,657,582 KRW). The incremental cost-effectiveness of anidulafungin compared with fluconazole was estimated to be 3,532,684 KRW. CONCLUSIONS: Anidulafungin indicated better clinical efficacy in managing candidemia or invasive candidiasis. Although there is an increase in drug costs, treating candidemia or invasive candidiasis with anidulafungin is a cost-effectiveness strategy. This study shows that anidulafungin as first-line therapy can be cost-effectiveness alternative to fluconazole in candidemia or invasive candidiasis treatment.