Pharmacoeconomic analysis of the anidulafungin (EraxisR) in adult patients with invasive candidiasis

Objective: to assess the economic outcomes of using anidulafungin (Eraxis®) in comparison with the recommended treatment regimens in adult patients with invasive candidiasis.

Materials and methods. The economic impact assessment was carried out using “cost–effectiveness” analysis and “budget impact” analysis. “Cost–effectiveness” and “budget impact” analyses were performed in Microsoft Excel model.

Results. An analysis of the effectiveness showed that the use of anidulafungin is characterized by higher survival (79.25 % vs 66.17 % for caspofungin and 60.84 % for mikafungin). The cost of anidulafungin was 377.7 thousand rubles, which is comparable with the course of caspofungin and 61 % lower than the cost of micafungin therapy. “Cost–effectiveness” analysis showed that the use of the anidulafungin in the treatment of invasive candidiasis is pharmacoeconomically effective and has a “cost–effectiveness” ratio comparable to caspofungin in terms of the effectiveness of therapy for 7 days and exceeds it in terms of the cost of preserving the patient»s life by 14.5 %. Compared to micafungin, anidulafungin is both more economical and more effective in terms of preserving the patient's life, reaching an advantage of up to 45 %. An analysis of the impact on the budget showed that with the complete replacement of the currently used treatment regimens in the target population of 11,840 patients with invasive candidiasis with anidulafungin, it is possible to reduce the burden on the budget of the healthcare system to 17 % or 1458.6 million rubles in year. The average savings in the 3‑year study horizon, taking into account the gradual switching of 25, 50 and 75 % of the target patient population, amounted to 1277.9 million rubles per year or 14.4 %. A sensitivity analysis confirmed the results.

Conclusion. Based on results, it can be concluded that the use of the drug anidulafungin (Eraxis®) in patients with invasive candidiasis is economically the preferred option compared to the use of current antibiotic therapy regimens.

1. Diagnosis and treatment of mycoses in the intensive care unit: Russian recommendations. Ed.: N.N. Klimko 2nd edn., revised. Moscow: Farmtek, 2015. 96 p. (In Russ.).

2. Vasilieva N.V., Klimko N.N., Tsinzerling V.A. Diagnosis and treatment of invasive mycoses: current recommendations. Vestnik Severo-Zapadnogo gosudarstvennogo meditsinskogo universiteta im. I.I. Mechnikova = Bulletin of the North-Western State Medical University named after I.I. Mechnikov 2010;2(4):5‒18. (In Russ.).

3. Veselov A.V., Kozlov R.S. Invasive candidiasis: current aspects of epidemiology, diagnosis, therapy and prevention in various subgroups of patients. Klinicheskaya mikrobiologiya i antimikrobnaya terapiya = Clinical Microbiology and Antimicrobial Chemotherapy 2016;18(2):3‒87. (In Russ.).

4. Klimko N.N. Invasive candidiasis in intensive care units: results of prospective multicenter study in Russia. Proceedings of the 25th ECCMID, 2015.

5. Cornely O.A., Bassetti M., Calandra T. et al. ESCMID guideline for the diagnosis and management of Candida diseases 2012: non-neutropenic adult patients. Clin Microbiol Infect 2012;18(7):19‒37. DOI: 10.1111/14690691.12039.

6. Pappas P.G., Kauffman C.A., David R. et al. Clinical practice guideline for the managementof candidiasis: 2016 update by the infectious diseases society of America. Clin Infect Dis 2016;62:e1‒50.

7. Klimko N.N., Rubinchik V.E., Sobol M.M. et al. The results of a prospective multicenter study of Anidulafungin administration ‒ ERA (Eraxis® in the Russian Federation). Problemy meditsinskoy mikologii = Problems of Medical Mycology 2018;20(3):21‒6. (In Russ.).

8. Mills E.J., Perri D., Cooper C. et al. Antifungal treatment for invasive candida infec-tions: a mixed treatment comparison meta-analysis. An Clin Microbiol Antimicrob 2009;8(23):1‒11. DOI: 10.1186/1476-0711-8-23.

9. Order of the Ministry of Health of the Russian Federation on October 26, 2017 No. 871н “On approval of the Procedure for determining the initial (maximum) price of a contract, the price of a contract concluded with a single supplier (contractor, contractor) when purchasing medicines for medical use”. (In Russ.).

10. Reis A.M., Cassiani S.H. Adverse drug events in an intensive care unit of a university hospital. Eur Clin Pharmacol 2011;67(6):625‒32. DOI: 10.1007/s00228-010-0987-y.

11. Uchino S., Kellum J.A., Bellomo R. et al. Acute renal failure in critically ill patients: a multinational, multicenter study. Jama 2005;294(7):813‒8. DOI: 10.1001/jama.294.7.813.

12. Methodological guidelines on calculation of costs in clinical and economic studied of medicines. Approved by the Order of the Center for Medical Care Expertise and Quality Control of the Ministry of Health of Russia from 23.12.2016 № 145-од. Available at: http://rosmedex.ru/ocenka-texnologijzdravooxraneniya/metodicheskierekomendacii/. (In Russ.).

13. Methodological guidelines on evaluation of the effect on budget under the Program of State Guarantee of Free Medical Care to the Citizens of the Russian Federation by the Ministry of Health of Russia from 23.12.2016 № 145-од. Available at: http://rosmedex.ru/ocenkatexnologijzdravooxraneniya/metodicheskierekomendacii/. (In Russ.).

14. www.LIFE-worldwide.org.

15. Klimko N.N., Kozlova Ya.I., Khostelidi S.N. The prevalence of severe and chronic mycosis in the Russian Federation according to the Life Program model. Problemy meditsinskoy mikologii = Problems of Medical Mycology 2014;16(1):3‒8. (In Russ.).