Assessment of the Efficacy , Safety and Cost-Effectiveness of Micafungin Compared to Caspofungin and Low Dose Liposomal Amphotericin B for the Treatment of Candidaemia and Clinically Diagnosed Invasive Candidiasis : A Retrospective

Introduction Assessment of the Efficacy, Safety and Cost-Effectiveness of Micafungin Compared to Caspofungin and Low Dose Liposomal Amphotericin B for the Treatment of Candidaemia and Clinically Diagnosed Invasive Candidiasis: A Retrospective Audit Habayeb H*1, Grundy C2, and Barker M1 1Pharmacy Department, Ashford & St. Peter’s Hospitals NHS Foundation Trust, Surrey, United Kingdom 2Microbiology Department, Ashford & St. Peter’s Hospitals NHS Foundation Trust, Surrey, United Kingdom *Corresponding author: Habayeb H, Pharmacy Department, Ashford & St. Peter’s Hospitals NHS Foundation Trust, Guildford Road, Chertsey, KT16 0PZ Surrey, United Kingdom, Tel: +44-77 99 83 45 18, E-mail: hanihabayeb@yahoo.co.uk Citation: Habayeb H, Grundy C, and Barker M (2018) Assessment of the Efficacy, Safety and Cost-Effectiveness of Micafungin Compared to Caspofungin and Low Dose Liposomal Amphotericin B for the Treatment of Candidaemia and Clinically Diagnosed Invasive Candidiasis: A Retrospective Audit. J Microbiol Modern Tech 3(1): 102 Research Article Open Access Despite several studies having highlighted that candidaemia and invasive fungal disease (IFD) are associated with high mortality and increased costs, there are currently few published studies which provide an insight into real-life practice of invasive candidal diseases. In a medium-sized district general hospital in the UK we sought to compare the efficacy, safety and treatment cost of micafungin versus caspofungin and low dose of liposomal amphotericin B (L-AmB) 1mg/kg/day for the treatment of confirmed candidaemia or clinically diagnosed invasive fungal disease (CDIFD). In the present retrospective audit, a total of 126 patients with candidaemia or CDIFD were reviewed from hospital records and 94 were included in our audit. Twenty-eight had candidaemia and 66 had CDIFD. At baseline, the three treatment arms were comparable in relation to demographics and severity of disease. Presence of Candida nonalibicans species were high both in candidaemia and CDIFD among which C. glabrata or C. koseri confirming the need to adapt the empirical treatment based on the local epidemiology. The clinical and microbiological successes were comparable between groups but, significant differences were observed in terms of safety and treatment cost. Micafungin was the drug the most frequently associated with hepatotoxicity (28%) compared to caspofungin (3%, P<0.05) and L-AmB group (P<0.005). L-AmB appears to be the cheapest drug (total treatment cost) with a mean cost of £2782 compared to £3986 for micafungin (P<0.005) and £4616 for caspofungin (P<0.0001). The present audit suggests that using low dose of L-AmB (1mg/kg/day), a favourable benefit/risk balance is obtained when compared to micafungin and a favourable cost-benefit is reached when compared to caspofungin and micafungin. Further prospective studies may be useful to study more in depth the clinical advantage of low dose L-AmB compared to other antifungal therapies.