Cost-Effectiveness Analysis of Five Competing Strategies for the Management of Multiple Recurrent Community-Onset Clostridium difficile Infection in France

Baro, Emilie; Galpérine, Tatiana; Deniès, Fanette; Lannoy, Damien; Lenne, X.; Odou, Pascal; Guery, Benoît; Dervaux, B.

doi:10.1371/journal.pone.0170258

Cited by 40 publications

(51 citation statements)

References 77 publications

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“…This has recently been shown for perceived expensive therapeutic options such as directly acting anti‐virals and with strategies for screening for hepato‐cellular cancer, among others . Other microbial strategies found to be cost‐effective are faecal microbial transplantation for C difficile . Our data are the first to determine this from a microbial diagnostic perspective in cirrhosis and could help translate this burgeoning field towards clinical practice.…”

Section: Discussionmentioning

confidence: 77%

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Cost‐effectiveness of integrating gut microbiota analysis into hospitalisation prediction in cirrhosis

et al. 2020

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Summary Background Admissions in cirrhosis are expensive and often unpredictable based on purely clinical variables. Admissions could be related to complications associated with gut microbial changes, which can improve prognostication. However, the cost‐effectiveness remains unclear. Aims Determine cost‐effectiveness of adding gut microbiota analysis to clinical parameters in prediction and subsequent reduction of admissions in cirrhosis. Methods Using a Markov model of 1000 cirrhosis patients over 90 days, we modelled microbiota testing using 16srRNA ($250/sample), low‐depth ($350/sample) and high‐depth ($650/sample) metagenomics added to standard‐of‐care (SOC) for prevention of admissions using standard outcome costs and rates of development. We generated quality of life years (QALY) and Incremental cost‐effectiveness ratios (ICER) for the base scenarios and performed sensitivity analyses by varying costs for outcomes (transplant, death, admission) and admission rates (40%, range 25%‐60%). Results Using fixed costs of outcomes and outcome rates, microbiota analysis was cost‐saving ($47K‐$97K) at $250 and $350/sample if admissions were reduced by 5% over SOC and >10% with $650/sample. When costs of liver transplant, death and admissions were varied, these cost‐savings remained robust provided there was >2.1% reduction (range 1.3%‐3.2%) for $250/sample, >2.9% (range 1.8%‐4.4%) for $350/sample and >5.4% (range 3.3%‐8.2%) for $650/sample. These cost‐savings remained robust even when the assumed admission rate was varied for all sample cost values. Conclusions Gut microbiota analysis is cost‐effective for predicting and potentially preventing 90‐day admissions in cirrhosis over current SOC. This cost‐saving remained robust even after sensitivity analyses that varied the background admission rates.

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Section: Discussionmentioning

confidence: 77%

“…32,33 Other microbial strategies found to be cost-effective are faecal microbial transplantation for C difficile. [34][35][36] Our data are the first to determine this from a microbial diagnostic perspective in cirrhosis and could help translate this burgeoning field towards clinical practice.…”

Section: Discussionmentioning

confidence: 89%

Cost‐effectiveness of integrating gut microbiota analysis into hospitalisation prediction in cirrhosis

et al. 2020

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“…In total, 9 articles were analyzed and eligible for the systematic review (Appendix B online). [44][45][46][47][48][49][50][51][52] Articles identified in literature search: 46…”

Section: Article Selectionmentioning

confidence: 99%

A systematic review of economic evaluation in fecal microbiota transplantation

Stalder

Kapel

Diaz

et al. 2020

Infect. Control Hosp. Epidemiol.

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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.

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“…A survey showed that among patients of Crohn's disease who received FMT, 56% showed satisfactory clinical efficacy, 74% showed willingness for a second FMT, and 89% expressed willingness to recommend FMT to other patients [171]. Also, the cost efficacy of FMT has been demonstrated worldwide [172][173][174][175][176]177]. FMT is still very far from being implemented into routine therapy.…”

Section: The Importance Of Safe Fmtmentioning

confidence: 99%

The Therapeutic Potential of the “Yin-Yang” Garden in Our Gut

Srikumar¹,

Fanning²

2019

Role of Microbes in Human Health and Diseases

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The gut microbiota is made up of trillion microorganisms comprising bacteria, archaea, and eukaryota living in an intimate relationship with the host. This is a highly diverse microbial community and is essentially an open ecosystem despite being deeply embedded in the human body. The gut microbiome is continually exposed to allochthonous bacteria that primarily originates from food intake. Comprising more than 1000 bacterial species, the gut microbiota endows so many different functions-so many that can be considered as an endocrine organ of its own. In this book chapter, we summarize the importance of gut microbiota in the development and maintenance of a healthy human body. We first describe how the gut microbiota is formed during the birth of a human baby and how a healthy microflora is established overtime. We also discuss how important it is to maintain the microbiota in its homeostatic condition. A discussion is also given on how alterations in the microbiota are characteristic of many diseased conditions. Recent investigations report that reestablishing a healthy microbiota in a diseased individual using fecal microbial transplant can be used as a therapeutic approach in curing many diseases. We conclude this chapter with a detailed discussion on fecal microbial transplants.

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Cost-Effectiveness Analysis of Five Competing Strategies for the Management of Multiple Recurrent Community-Onset Clostridium difficile Infection in France

Cited by 40 publications

References 77 publications

Cost‐effectiveness of integrating gut microbiota analysis into hospitalisation prediction in cirrhosis

Cost‐effectiveness of integrating gut microbiota analysis into hospitalisation prediction in cirrhosis

A systematic review of economic evaluation in fecal microbiota transplantation

The Therapeutic Potential of the “Yin-Yang” Garden in Our Gut

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