Cost-Effectiveness of Competing Treatment Strategies for <i>Clostridium difficile</i> Infection: A Systematic Review

Le, Phuc; Nghiem, Van T.; Mullen, Patricia Dolan; Deshpande, Abhishek

doi:10.1017/ice.2017.303

Cited by 33 publications

(29 citation statements)

References 49 publications

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“…Accounting for the risk of recurrence favors fidaxomicin due to averted recurrence and its associated mortality and healthcare costs. Two recent systematic reviews of economic evaluations support our findings that fidaxomicin is a cost-effective option in initial and recurrent CDI [23] and FMT is cost-effective in recurrent CDI [24].…”

Section: Discussionsupporting

confidence: 85%

Cost-effectiveness of Treatment Regimens for Clostridioides difficile Infection: An Evaluation of the 2018 Infectious Diseases Society of America Guidelines

Rajasingham

Enns

Khoruts

et al. 2019

Clinical Infectious Diseases

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Background In 2018, the Infectious Diseases Society of America (IDSA) published guidelines for diagnosis and treatment of Clostridioides (formerly Clostridium) difficile infection (CDI). However, there is little guidance regarding which treatments are cost-effective. Methods We used a Markov model to simulate a cohort of patients presenting with an initial CDI diagnosis. We used the model to estimate the costs, effectiveness, and cost-effectiveness of different CDI treatment regimens recommended in the recently published 2018 IDSA guidelines. The model includes stratification by the severity of the initial infection, and subsequent likelihood of cure, recurrence, mortality, and outcomes of subsequent recurrences. Data sources were taken from IDSA guidelines and published literature on treatment outcomes. Outcome measures were discounted quality-adjusted life-years (QALYs), costs, and incremental cost-effectiveness ratios (ICERs). Results Use of fidaxomicin for nonsevere initial CDI, vancomycin for severe CDI, fidaxomicin for first recurrence, and fecal microbiota transplantation (FMT) for subsequent recurrence (strategy 44) cost an additional $478 for 0.009 QALYs gained per CDI patient, resulting in an ICER of $31 751 per QALY, below the willingness-to-pay threshold of $100 000/QALY. This is the optimal, cost-effective CDI treatment strategy. Conclusions Metronidazole is suboptimal for nonsevere CDI as it is less beneficial than alternative strategies. The preferred treatment regimen is fidaxomicin for nonsevere CDI, vancomycin for severe CDI, fidaxomicin for first recurrence, and FMT for subsequent recurrence. The most effective treatments, with highest cure rates, are also cost-effective due to averted mortality, utility loss, and costs of rehospitalization and/or further treatments for recurrent CDI.

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Section: Discussionsupporting

confidence: 85%

Cost-effectiveness of Treatment Regimens for Clostridioides difficile Infection: An Evaluation of the 2018 Infectious Diseases Society of America Guidelines

Rajasingham

Enns

Khoruts

et al. 2019

Clinical Infectious Diseases

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“…Comment: In the context of CDI, FMT has consistently been shown to be cost-effective compared with other potential therapeutic options, even when evaluated in a variety of global healthcare settings 64. Nevertheless, in most cases funding of FMT services has been historically provided ad hoc by teaching hospitals/academic centres, and FMT services sometimes run with a financial deficit 65 66.…”

Section: Resultsmentioning

confidence: 99%

“…Animal studies have indicated that the composition of the gut microbiota can affect host susceptibility to diseases,72 and human studies have consistently shown that FMT durably alters the microbiome of the recipient 73 74. FMT is unlike other treatments in that it was rapidly adopted for widespread clinical use, bypassing the drug-development process, which typically collects prospective efficacy and safety data on large numbers of patients before making a treatment available 64 75. Therefore, it is important to collect real-world evidence for the short- and long-term safety of the procedure.…”

Section: Resultsmentioning

confidence: 99%

International consensus conference on stool banking for faecal microbiota transplantation in clinical practice

Cammarota

Ianiro

Kelly

et al. 2019

Gut

363

375

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Although faecal microbiota transplantation (FMT) has a well-established role in the treatment of recurrent Clostridioides difficile infection (CDI), its widespread dissemination is limited by several obstacles, including lack of dedicated centres, difficulties with donor recruitment and complexities related to regulation and safety monitoring. Given the considerable burden of CDI on global healthcare systems, FMT should be widely available to most centres.Stool banks may guarantee reliable, timely and equitable access to FMT for patients and a traceable workflow that ensures safety and quality of procedures. In this consensus project, FMT experts from Europe, North America and Australia gathered and released statements on the following issues related to the stool banking: general principles, objectives and organisation of the stool bank; selection and screening of donors; collection, preparation and storage of faeces; services and clients; registries, monitoring of outcomes and ethical issues; and the evolving role of FMT in clinical practice,Consensus on each statement was achieved through a Delphi process and then in a plenary face-to-face meeting. For each key issue, the best available evidence was assessed, with the aim of providing guidance for the development of stool banks in order to promote accessibility to FMT in clinical practice.

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“…[44][45][46][47][48][49][50][51][52] Another review that included only 4 studies about FMT in rCDI also concluded that FMT was cost-effective. 55 FMT was considered cost-effective if it was less expensive and more effective than other treatments (FMT was dominant). 44,47,48,52 Otherwise, FMT was more expensive but more effective compared with other treatments.…”

Section: Discussionmentioning

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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Cost-Effectiveness of Competing Treatment Strategies for Clostridium difficile Infection: A Systematic Review

Cited by 33 publications

References 49 publications

Cost-effectiveness of Treatment Regimens for Clostridioides difficile Infection: An Evaluation of the 2018 Infectious Diseases Society of America Guidelines

Cost-effectiveness of Treatment Regimens for Clostridioides difficile Infection: An Evaluation of the 2018 Infectious Diseases Society of America Guidelines

International consensus conference on stool banking for faecal microbiota transplantation in clinical practice

A systematic review of economic evaluation in fecal microbiota transplantation

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