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An Economic Evaluation of Anidulafungin in the Treatment of Invasive Candidiasis in Korea

An Economic Evaluation of Anidulafungin in the Treatment of Invasive Candidiasis in Korea. Jae-Young Lim (Korea University). Cost-Effectiveness Analysis (1). Anidulafungin (Eraxis ® ): IV Selected comparators: * Based on the market data in 2007. † Weighted average values from 2007 data.

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An Economic Evaluation of Anidulafungin in the Treatment of Invasive Candidiasis in Korea

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  1. An Economic Evaluation of Anidulafungin in the Treatment of Invasive Candidiasis in Korea Jae-Young Lim (Korea University)

  2. Cost-Effectiveness Analysis (1) • Anidulafungin (Eraxis®): IV • Selected comparators: * Based on the market data in 2007. † Weighted average values from2007 data.

  3. Cost-Effectiveness Analysis (2) • Costs * Direct Costs associated with invasive candidiasis Tx antifungal drug costs, ICU and other hospital room and board costs, laboratory costs, costs of renal toxicity, etc.. • Cost Data in Korea were collected from * health insurance claims, * Health Insurance Review and Assessment, * experts in the related clinical fields.

  4. Cost-Effectiveness Analysis (3) • Decision Tree Model

  5. Assumptions of the study 1. Clinical Success: resolution of signs and symptoms of invasive candidiasis and no additional systemic antifungal therapy required. 2. Clinical Failure: No significant improvement in signs and symptoms, death due to invasive candidiasis, persistent recurrence, a new Candida infection, or any indeterminate response. 3. Only two lines of treatment are needed to clear the infection. 4. Overall treatment duration is constant throughout the study (treatment duration is similar for those patients who are successfully treated and those patients who are not successfully treated).

  6. Input Parameters (Probabilities-1) • Clinical Success and Failure

  7. Input Parameters (Probabilities-2) • Survival Probabilities (6-Week Follow-Up)

  8. Input Parameters (Probabilities-3) • Renal Toxicity and Switching to Oral Therapy

  9. Input Parameters (Timing Inputs) • Treatment Duration • Time until First-Line Clinical Failure Our model assumes the time to first-line failure to be 3 days, which is similar to what would be found in invasive candidiasis patients who experience clinical failure with or without renal toxicity (Wenzel et al. (2005)).

  10. Other Medical Costs Inputs (1) • Mean ICU and LOS with ICU Room and other Board Costs per day (Clinical Success Patients)

  11. Other Medical Costs Inputs (2) • Mean other Hospital LOS and other Hospital Room and Board Costs per day (Clinical Success Patients)

  12. Other Medical Costs Inputs (3) • Mean ICU and LOS with ICU Room and other Board Costs per day (Clinical Failure Patients)

  13. Other Medical Costs Inputs (4) • Mean other Hospital LOS and other Hospital Room and Board Costs per day (Clinical Failure Patients)

  14. Other Medical Costs Inputs (5) • Mean Laboratory Costs per day • Renal Toxicity: hemodialysis, IV fluids due to nephrotoxicity KRW 433,844/day*1.088 (2006 CPI)=KRW 472,022/day KRW 3,304,154 (assuming 7 days of hemodialysis on average) Kidney Sonography= KRW139,000, General tests such as CBC, BC, Urine Analysis and Chemistry: 2 times/wk*3months=KRW500,000*12weeks=KRW6,000,000 Inpatient fee*3months= KRW50,000*90days= KRW4,500,000 Total Costs: KRW 13,943,000

  15. Estimated Costs by Model Comparators (1)

  16. Estimated Costs by Model Comparators (2)

  17. ICERs for incremental cost per successfully treated patient gained

  18. ICERs for incremental cost per Life Saved

  19. An Explanation of Terms Used in ICER

  20. One-way Probabilistic Sensitivity Analysis • Anidulafungin and Fluconazole are model comparators with head-to-head data. So, the one-way sensitivity analysis is conducted on the uncertainty of input parameters for those two comparators.

  21. Results of Sensitivity Analysis (1)

  22. Results of Sensitivity Analysis (2)

  23. Tornado Diagram(1)

  24. Tornado Diagram(2)

  25. Conclusions • Anidulafungin was more efficacious than Fluconazole in the treatment of candidemia and other Candida infections. • Anidulafungin was efficacious across a broad population, particularly in moderate-risk ICU patients. • Anidulafungin demonstrated excellent safety, with fewer discontinuations than in the Fluconazole arm. • Anidulafungin treatment resulted in increased survival at the end of all therapy, compared with that of Fluconazole treatment (77.17% vs. 68.65%). • For the antifungal treatment with IV, the study shows that Anidulafungin is cost-effective versus Fluconazole, Amphotericin B, and Caspofungin depending upon the applicable cost-effectiveness threshold. • As a second treatment method, FLU/AND shows dominant cost-effectiveness in comparison with any other treatment matching.

  26. Questions and Comments

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