A systematic review of economic evaluation in fecal microbiota transplantation

Abstract

Background:Fecal microbiota transplantation (FMT) is an effective therapy in recurrent Clostridium difficile infection (rCDI). It is only recommended for this indication by European and American guidelines. Other indications of FMT are being studied, such as inflammatory bowel disease (IBD), and they have shown promising results.Objectives:To identify and review published FMT-related economic evaluations (EEs) to assess their quality and the economic impact of FMT in the treatment of these diseases.Data sources:The systematic literature research was conducted in both PubMed and Cochrane to identify EEs published before July 1, 2019.Study eligibility criteria:Articles were included if they concerned FMT (whatever the disease and its line of treatment), if they reported full or partial EEs, and if they were written in English. Articles were excluded if they did not concern FMT; if they did not report an EE; or if they were a systematic review, editorial, comment, letter to the editor, practice point, or poster.Methods:A measurement tool, AMSTAR, was used to optimize the quality of this systematic review. Based on the CHEERS checklist, data were identified and extracted from articles. The quality of each EE was assessed using the Drummond checklist.Results:Overall, 9 EEs were included: all EEs were full evaluations and 8 were cost-utility analyses (CUAs). All EEs had a Drummond score ≥ 7, which indicated high quality. All CUAs related to rCDI and IBD concluded that FMT was cost-effective compared with other reference treatments, at a threshold ≤$50,000/QALY. One EE about initial CDI showed that FMT was dominated by metronidazole.Conclusions:Despite a limited number of EEs, FMT seems to be a promising and cost-effective treatment for rCDI. More EE studies on other diseases like IBD are necessary to address FMT efficiency for new indications. Therefore, our systematic review provides a framework for healthcare decision making.

Fecal microbiota transplantation for treatment of refractory or recurrent Clostridioides difficile infection in Taiwan: a cost-effectiveness analysis

“…The cost-effective analysis from the payer's perspective is crucial for health authorities to create a reimbursement policy for FMT in rCDI. Despite the limited number of cases, variations in antibiotic and FMT costs, and the heterogeneous study designs of published FMT-related economic evaluation studies across different countries, the latest systematic review published in 2020 concludes that FMT appears to be a cost-effective treatment for rCDI ( 31 ). However, only one study from Hong Kong based on publicly available data revealed superior cost-effectiveness of FMT in IBD patients with rCDI, relative to antibiotic treatment ( 17 ).…”

The American Society of Colon and Rectal Surgeons Clinical Practice Guidelines for the Management of Clostridioides difficile Infection

“…Randomized, controlled trials, systematic reviews, and meta-analyses suggest that patients with recurrent or refractory CDI in whom medical treatment has failed should be considered for fecal transplantation. 209,[213][214][215][216][217][218][219] In general, conventional antibiotic treatment should be used for at least 2 recurrences (ie, 3 CDI episodes) before offering fecal microbiota transplantation. 18 In terms of the technical aspects involved, randomized, controlled trials have shown similar CDI cure rates after fecal transplants performed with fresh and frozen fecal samples.…”

Health economic evaluations comparing faecal microbiota transplantation with antibiotics for treatment of recurrent Clostridioides difficile infection: a systematic review

“…Given the growing interest in the use of FMT for rCDI treatment [ 17 ], it becomes important to support healthcare decision-making regarding the implementation of FMT in clinical practice. Previous systematic reviews have evaluated the cost-effectiveness of providing FMT for both index CDI and rCDI and have highlighted several concerns about the methodological quality of existing health economic evaluations [ 18 , 19 ]. However, the impact of these concerns on the conclusions of the studies has yet to be evaluated.…”