The objective of this paper was to assess the cost-utility of fidaxomicin versus vancomycin in the treatment of Clostridium difficile infection (CDI) in three specific CDI patient subgroups: those with cancer, treated with concomitant antibiotic therapy or with renal impairment. A Markov model with six health states was developed to assess the cost-utility of fidaxomicin versus vancomycin in the patient subgroups over a period of 1 year from initial infection. Cost and outcome data used to parameterise the model were taken from Spanish sources and published literature. The costs were from the Spanish hospital perspective, in Euros (€) and for 2013. For CDI patients with cancer, fidaxomicin was dominant versus vancomycin [gain of 0.016 quality-adjusted life-years (QALYs) and savings of €2,397 per patient]. At a cost-effectiveness threshold of €30,000 per QALY gained, the probability that fidaxomicin was cost-effective was 96 %. For CDI patients treated with concomitant antibiotic therapy, fidaxomicin was the dominant treatment versus vancomycin (gain of 0.014 QALYs and savings of €1,452 per patient), with a probability that fidaxomicin was cost-effective of 94 %. For CDI patients with renal impairment, fidaxomicin was also dominant versus vancomycin (gain of 0.013 QALYs and savings of €1,432 per patient), with a probability that fidaxomicin was cost-effective of 96 %. Over a 1-year time horizon, when fidaxomicin is compared to vancomycin in CDI patients with cancer, treated with concomitant antibiotic therapy or with renal impairment, the use of fidaxomicin would be expected to result in increased QALYs for patients and reduced overall costs.

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comycin in the treatment of adult CDI patients. The analysis focused on three CDI patient subgroups: cancer, concomitant antimicrobials, and renal impaired patients. Methods: A Markov model was developed with a cycle length of 10 days and a one year time horizon. The patient enters the model in the CDI health state and is treated with fidaxomicin, or vancomycin for 10 days. Health state utilities were derived from the literature. The model perspective was the Spanish health care provider. Deterministic and probabilistic sensitivity analyses were performed. Results: In all three CDI patient subgroups, fidaxomicin was dominant compared to vancomycin. For cancer fidaxomicin resulted in cost savings of € 2,397 with an incremental QALY gain of 0.016. For concomitant antibiotics fidaxomicin resulted in cost savings of € 1,452 with an incremental QALY gain of 0.014. For renally impaired, fidaxomicin resulted in cost savings of € 1,432 and an incremental QALY gain of 0.013. The main cost-effectiveness drivers were the recurrence rate and length of hospital stay. The probability of fidaxomicin being cost effective at the € 30,000 threshold was 96%, 94% and 96% respectively for cancer, concomitant antimicrobials and renal impairment, respectively. ConClusions: Fidaxomicin was dominant compared to vancomycin for these adult CDI patient subgroups.

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