Cost-Effectiveness Of Various Clostridium Difficile Infection (CDI) Treatments In Patients With Recurrent Infections

Abstract

A273 from remission, progression to long-term adverse outcomes (cirrhosis, decompensated cirrhosis, hepatocellular carcinoma, end-stage liver disease) and commonly observed side effects (anemia, neutropenia and rash) along with a gradient of their severity. Model inputs were determined from a review of the published literature and phase II or III clinical trials. Clinical trials estimates were converted to risk ratios to facilitate comparison. Costs were inflated to 2013 US dollars. Costs and quality adjusted life years were discounted at standard rate of 5%. Sensitivity analyses were performed to assess model sensitivity and address uncertainty. Results: Relative to treatment with PR only, response-guided triple therapy with BOC+PR was the most cost effective therapy (ICER $28,723/QALY) followed by responseguided triple therapy with TVR+PR (ICER $64,569/QALY). PR treatments with SIM or SOF were dominated by BOC+PR. The model was sensitive to variations in costs of initial drug therapy and likelihood of attaining SVR. ConClusions: Addition of protease inhibitors to PR therapy improves health outcomes. Response-guided regimen BOC+PR was found to be cost-effective for treating newly diagnosed genotype 1 HCV patients. Shortening of PR therapy guided by a rapid virologic response may help reduce overall costs. Robust sensitivity analyses can help in overcoming the challenge of sparse data availability.

A Systematic Literature Review of Economic Evaluations of Antibiotic Treatments for Clostridium difficile Infection

“…Of the 13 EEs reported as full publications, six [ 26 , 27 , 46 , 58 , 62 , 65 ] had previously been presented at a conference [ 38 , 41 , 45 , 52 , 63 , 66 ] and posters were sourced for all except one [ 45 ]. For the remaining EEs, the data were reported in abstract ( n = 7) [ 36 , 39 , 49 , 53 , 54 , 56 , 57 , 59 ] or poster form ( n = 7) only [ 40 , 43 , 44 , 47 , 51 , 60 , 61 , 64 ].…”

“…Vancomycin was assessed in all 27 EEs, whereas fidaxomicin and metronidazole were investigated in 24 EEs [ 26 – 28 , 36 , 37 , 39 , 40 , 42 , 43 , 46 – 51 , 54 , 56 – 60 , 62 , 64 ] and 13 EEs [ 37 , 44 , 46 – 49 , 51 , 54 , 55 , 57 , 59 , 62 , 65 ], respectively. In two EEs [ 37 , 57 ], vancomycin and metronidazole were combined in a single treatment arm and the intervention used was based on CDI severity or C. difficile strain.…”

“…In two EEs [ 37 , 57 ], vancomycin and metronidazole were combined in a single treatment arm and the intervention used was based on CDI severity or C. difficile strain. FMT was not a comparator of interest, but was a treatment arm in six of the EEs included [ 46 , 48 , 51 , 54 , 59 , 65 ].…”

“…Five EEs [ 37 , 47 , 49 , 57 , 62 ] compared fidaxomicin with vancomycin and metronidazole. FMT was compared to the three antibiotics in five EEs [ 46 , 48 , 51 , 54 , 59 ] and to vancomycin and metronidazole alone in one EE [ 65 ]. Vancomycin and metronidazole only were compared in two EEs [ 44 , 55 ].…”

“…A Markov model was used in ten EEs [ 26 , 27 , 47 , 48 , 50 , 56 , 58 , 60 , 62 , 64 ], and a decision-tree model was used in 11 EEs [ 28 , 36 , 37 , 40 , 43 , 46 , 51 , 54 , 55 , 65 ]. Four EEs [ 39 , 44 , 49 , 59 ] used a decision-analytic model, but no further details were provided in the publications.…”