Cost ‐effectiveness analysis of treatment strategies for initial Clostridium difficile infection

This study explores the cost‐effectiveness of FMT, vancomycin and metronidazole for initial CDI. We constructed a decision‐analytic computer simulation using inputs from published literature to compare FMT with a 10–14‐day course of oral metronidazole or vancomycin for initial CDI. Parameters included cure rates (baseline value (range)) for metronidazole (80% (65–85%)), vancomycin (90% (88–92%)) and FMT(91% (83–100%)). Direct costs of metronidazole, vancomycin and FMT, adjusted to 2011 dollars, were $57 ($43–72), $1347 ($1195–1499) and $1086 ($815–1358), respectively. Our effectiveness measure was quality‐adjusted life years (QALYs). One‐way and probabilistic sensitivity analyses were conducted from the third‐party payer perspective. Analysis using baseline values showed that FMT($1669, 0.242 QALYs) dominated (i.e. was less costly and more effective) vancomycin ($1890, 0.241 QALYs). FMT was more costly and more effective than metronidazole ($1167, 0.238 QALYs), yielding an incremental cost‐effectiveness ratio (ICER) of $124 964/QALY. One‐way sensitivity analyses showed that metronidazole dominated both strategies if its probability of cure were >90%; FMT dominated if it cost <$584. In a probabilistic sensitivity analysis at a willingness‐to‐pay threshold of $100 000/QALY, metronidazole was favoured in 55% of model iterations; FMT was favoured in 38%. Metronidazole, as the first‐line treatment for CDIs, is less costly. FMT and vancom...
Source: Clinical Microbiology and Infection - Category: Microbiology Authors: Tags: Original Article Source Type: research