OBJECTIVES: To perform cost-effectiveness analysis of anidulafungin compared with all antifungal agents available in Colombia for the management of invasive candidiasis (IC), in neutropenic and non-neutropenic patients from the payer’s perspective.

METHODS: A decision model was designed to capture cost and effectiveness of first line IC treatment with anidulafungin, amphotericin B deoxycholate (AmB), amphotericin B liposomal (L-AmB), caspofungin, fluconazole and micafungin. Treatment duration and dose were chosen based on the recommendation of the IDSA. The effectiveness and safety data were taken from a systematic review and network meta-analysis of anidulafungin with the comparators. Quality adjusted life years (QALYs) was calculated as the number of years of survival and the utility for the patients surviving IC in the model. The costs contemplated were those related to the antifungal treatment, hospital stays, and nephrotoxicity as an adverse event. Costs were obtained from official data, SISMED and tariff manuals. QALYs were discounted at 5%. Sensitivity analyses were conducted.

RESULTS: The model indicated that anidulafungin dominated L-AmB, caspofungin and micafungin. Patients treated with anidulafungin experienced higher clinical success but had a higher total cost than AmB and fluconazole. The incremental cost-effective ratio (ICER) for anidulafungin was USD$ $5,916 with AmB, and USD$ 9,340 with fluconazole, which was below the gross domestic product (GDP) per capita. Anidulafungin was the treatment more likely to be cost effective (62.7%), followed by fluconazole (29.17%), AmB (4.11%), caspofungin (2.24%), micafungin (1.54%) and L-AmB (0.22%), in a USD$ 18,819 threshold.

CONCLUSIONS: The model suggests that anidulafungin is a cost-effective strategy compared with fluconazole and AmB for the treatment of IC and may be a cost-saving strategy compared to L-AmB and the other echinocandins in neutropenic and non-neutropenic patients from the Colombian healthcare system perspective.