A US Hospital-Perspective Decision-Analytic Model of Once-Weekly Rezafungin Versus Daily Echinocandin Therapy in Hospitalized Adults With Candidemia or Invasive Candidiasis: Potential Cost Savings From Earlier Discharge.

BACKGROUND

Hospitalized adults with candidemia or invasive candidiasis (C/IC) often remain inpatient to complete daily intravenous echinocandin therapy. Rezafungin, a once-weekly echinocandin, may facilitate earlier discharge in clinically stable patients. We evaluated its potential economic impact from a US hospital perspective.

METHOD: A decision-analytic probabilistic model compared 2 treatment-discharge strategies in 100 hypothetical hospitalized adults with C/IC who had reached clinical stability and were otherwise dischargeable: continued inpatient daily echinocandin therapy until observed discharge versus administration of a single 400 mg dose of rezafungin with earlier discharge. The rezafungin strategy incorporated earlier discharge distributions from a multicenter US study. Costs included antifungal acquisition, inpatient hospitalization during the final 4 hospital days, and peripherally inserted central catheter (PICC)-related costs (2026 US dollars). Deterministic, threshold, and probabilistic sensitivity analyses (10 000 Monte Carlo simulations) were performed, focusing on excess hospital costs.

RESULTS

In the base case, mean excess cost was lower with rezafungin than standard of care (SOC) (-$412 vs $708 per patient), corresponding to savings of $1120 per patient. Savings were greater when SOC required PICC placement (-$2269) versus no PICC placement (-$851). Rezafungin was associated with higher costs when no earlier discharge occurred (+$3471) or discharge occurred only 1 day earlier (+$1475), but became cost saving with ≥2 days earlier discharge (-$556 at 2 days, -$2903 at 3 days, and -$5313 at ≥4 days).

CONCLUSIONS

Once-weekly rezafungin reduced hospital costs versus daily echinocandins when it enabled discharge ≥2 days earlier, with greater savings when PICC placement was avoided.