Table 1.
Summary of model parameters
| Variable | Value [ref.] |
|---|---|
| Probability of success rate (%) | |
| All species | |
| Fluconazole | 63 [22] |
| Anidulafungin | 77.49 [22] |
| Micafungin | 75.98 [22] |
| Caspofungin | 76.10 [22] |
| C. albicans specific | |
| Echinocandins | 81 [8] |
| Non-echinocandins | 22a [7] |
| Non-albicans specific | |
| Echinocandins | 71 [8] |
| Non-echinocandins | 71a [7] |
| Probability of mortality (%) | |
| All species | |
| Fluconazole | 28.44 [22] |
| Anidulafungin | 20.75 [22] |
| Micafungin | 39.16 [22] |
| Caspofungin | 33.83 [22] |
| C. albicans specific | |
| Echinocandins | 19 [Pfizer, Data in file] |
| Non-echinocandins | 35a [7] |
| Non-albicans specific | |
| Echinocandins | 26 [Pfizer, Data in file] |
| Non-echinocandins | 50a [7] |
| Percentage that die during therapy (%) | 23.26 [25] |
| Life expectancy, mean (years) | 9.12 [9] |
| Length of IV treatment for patients with treatment success and then survival (days) | 14 [6, 18] |
| Major drug adverse events | |
| Nephrotoxicity probability for amphotericin B (%) | 33.7 [26] |
| Relative risk of nephrotoxicity of fluconazole compared with that of amphotericin B | 0.22 (95% CI, 0.15–0.32) [22] |
| Relative risk of nephrotoxicity of echinocandins compared with that of amphotericin B | 0.31 (95% CI, 0.17–0.57) [22] |
| Additional LOS for nephrotoxicity, mean (days) | 7 (95% CI, 5.7–8.4) [27] |
| Time required to determine clinical failure (days) | 5 [Expert opinion] |
| Follow up period (weeks) | 6 [Expert opinion] |
| Time to death for patients who had treatment success but died before 6-week follow-up, mean (weeks) | 3.25 [8] |
| Time to death for patients who had treatment failure that died before 6-week follow-up, mean (weeks) | 3.25 [8] |
| Average time to death during therapy (weeks) | 1 [Expert opinion] |
| ICU LOS (days)b | |
| Success and then survival | 7 [Expert opinion] |
| Success and then death | 7 [Expert opinion] |
| Failure and then survival | 14 [Expert opinion] |
| Failure and then death | 14 [Expert opinion] |
| Other hospital LOS (days)b | |
| Success and then survival | 23 [Expert opinion] |
| Success and then death | 23 [Expert opinion] |
| Failure and death survival | 23 [Expert opinion] |
| Failure and then death | 23 [Expert opinion] |
| Cost (US$) | |
| Loading dose cost | |
| Fluconazole 400 mg/day | 43.76 [28] |
| Anidulafungin 200 mg/day | 164.48 [28] |
| Micafungin 100 mg/day | 108.85 [28] |
| Caspofungin 70 mg/day | 517.70 [28] |
| Liposomal amphotericin B 3 mg/kg for a patient with 76.4 kg ± 25.5 kg | 962.61 [28] |
| Echinocandins | 263.67c [28] |
| Non-echinocandins | 43.76d [28] |
| Maintenance dose cost | |
| Fluconazole 400 mg/day | 43.76 [28] |
| Anidulafungin 100 mg/day | 82.24 [28] |
| Micafungin 100 mg/day | 108.85 [28] |
| Caspofungin 50 mg/day | 258.85 [28] |
| Liposomal amphotericin B 3 mg/kg for a patient with 76.4 kg (± 25.5 kg) | 962.61 [28] |
| Echinocandins | 149.97c [28] |
| Non-echinocandins | 43.76d [28] |
| ICU cost per day | 203.39 [28] |
| Other hospital cost per day | 43.27 [28] |
Abbreviations: LOS length of hospital stay, ICU intensive care unit
aTransformation of data from literature [7, 8]. Of note, because there appears to be no significant difference in the treatment success rate among the three echinocandins, we used the data (i.e., treatment success) for anidulafungin for C. albicans and non-albicans, respectively, in Reboli et al.’s study [8] for “echinocandins” for C. albicans and non-albicans. For example, Reboli et al.’s study [8] reported a success rate of anidulafungin treatment for C. albicans of 0.81 and Adnes et al.’s study [7] showed that the odds ratio for echinocandin treatment success as compared to that for non-echinocandins (including polyenes [amphotericin B and liposomal amphotericin B] and triazoles [fluconazole and voriconazole]) for C. albicans is 3.7, so the success rate of non-echinocandins was estimated to be 0.22. Similarly, Reboli et al.’s study [8] reported a success rate of anidulafungin treatment for non-albicans (including C. glabrate, C. parapsilosis, C. tropicalis, and other species) of 0.71 and Adnes et al.’s study [7] showed that the odds ratio for echinocandins treatment success as compared to that of non-echinocandins for non-albicans is 1, so the success rate of non-echinocandins for non-albicans was estimated to be 0.71. This transformation was also applied to estimate mortality rates for echinocandins and non-echinocandins for C. albicans and non-albicans, respectively
bAccording to clinical practice in Taiwan [16, 17], experts assumed an average of 30 days for total length of hospital stay (LOS), of which 7 days are for stay in intensive care unit (ICU) and 23 days are for other hospital stay
cAverage drug cost of echinocandins, including anidulafungin, micafungin, and caspofungin
dThe cost of non-echinocandins refers to drug cost of fluconazole