Cost-effectiveness analysis of fidaxomicin versus vancomycin in Clostridium difficile infection

Abstract

ObjectivesFidaxomicin was non-inferior to vancomycin with respect to clinical cure rates in the treatment of Clostridium difficile infections (CDIs) in two Phase III trials, but was associated with significantly fewer recurrences than vancomycin. This economic analysis investigated the cost-effectiveness of fidaxomicin compared with vancomycin in patients with severe CDI and in patients with their first CDI recurrence.MethodsA 1 year time horizon Markov model with seven health states was developed from the perspective of Scottish public healthcare providers. Model inputs for effectiveness, resource use, direct costs and utilities were obtained from published sources and a Scottish expert panel. The main model outcome was the incremental cost-effectiveness ratio (ICER), expressed as cost per quality-adjusted life year (QALY), for fidaxomicin versus vancomycin; ICERs were interpreted using willingness-to-pay thresholds of £20 000/QALY and £30 000/QALY. One-way and probabilistic sensitivity analyses were performed.ResultsTotal costs were similar with fidaxomicin and vancomycin in patients with severe CDI (£14 515 and £14 344, respectively) and in patients with a first recurrence (£16 535 and £16 926, respectively). Improvements in clinical outcomes with fidaxomicin resulted in small QALY gains versus vancomycin (severe CDI, +0.010; patients with first recurrence, +0.019). Fidaxomicin was cost-effective in severe CDI (ICER £16 529/QALY) and dominant (i.e. more effective and less costly) in patients with a first recurrence. The probability that fidaxomicin was cost-effective at a willingness-to-pay threshold of £30 000/QALY was 60% for severe CDI and 68% in a first recurrence.ConclusionsFidaxomicin is cost-effective in patients with severe CDI and in patients with a first CDI recurrence versus vancomycin.

Economic assessment of fidaxomicin for the treatment of Clostridium difficile infection (CDI) in special populations (patients with cancer, concomitant antibiotic treatment or renal impairment) in Spain

“…The Markov model used in this study was based on a previously published CDI model [17] (Fig. 1) with six health states fully described in Table 1.…”

Toxic megacolon associated with Clostridium difficile infection recurrence: a case report complicated by multiple bacterial infections and successfully treated with oral fidaxomicin

“…Fidaxomicina è un nuovo antibiotico disponibile in formulazione orale, appartenente alla classe degli antibatterici macrociclici, raccomandato nei pazienti con enterite grave sia al primo episodio sia nelle recidive in quanto si è mostrato capace di ridurre in maniera significativa l'incidenza di recidive e quella di complicanze che talvolta risultano fatali (megacolon tossico, colite pseudomembranosa) [17][18][19][20][21].…”

Prevention and treatment of Clostridium difficile infection

“…5 When oral administration of antibiotics is not feasible intravenous administration of metronidazole is the preferred choice, possibly in conjunction with intracolonic or nasogastric administration of vancomycin.…”