ABSTRACT Background Invasive candidiasis (IC), life‐threatening fungal infections with high economic burden, are often treated first‐line with daily intravenous echinocandins. A new once weekly echinocandin, rezafungin, demonstrated statistically non‐inferior efficacy and numerically shorter intensive care unit (ICU) stay compared to caspofungin in clinical trials, offering potential for earlier discharge. Objective To assess the cost‐effectiveness of rezafungin versus daily echinocandins for the treatment of IC from a UK healthcare perspective. Methods An economic model was developed including a short‐term decision tree (treatment duration ≤ 30 days) and a long‐term Markov model (for lifetime outcomes). Considering the impact IC has on a patient's life expectancy and quality of life, a cost‐utility analysis was performed. A cost‐minimisation analysis assuming similar efficacy among echinocandins was included as scenario analysis. Treatment response was assessed at days 5/14 with nonresponders switching to second‐line treatment. Patients with negative repeat blood cultures could step down to oral fluconazole. Rezafungin's weekly administration was estimated to lead to early discharge for 16% of patients. Risk of death was included. Efficacy and resource use estimates were from pooled trial data. Unit costs, utilities, long‐term mortality were from published literature and UK databases. Results Rezafungin was estimated to be cost‐saving compared to daily echinocandins (discounted incremental costs: −£6028 to −£6727 vs. daily echinocandins). Quality‐adjusted life‐years (QALYs) were similar (incremental QALY: 0.03 vs. daily echinocandins), resulting in rezafungin being cost‐effective. Results were most sensitive to varying mortality and ICU length of stay. Conclusion Once weekly rezafungin is a cost‐saving and cost‐effective treatment option in IC from the UK healthcare perspective.
Muszbek et al. (Sun,) studied this question.