A Review of the Economics of Treating Clostridium difficile Infection

Mergenhagen, Kari A.; Wojciechowski, Amy L.; Paladino, Joseph A.

doi:10.1007/s40273-014-0161-y

Cited by 26 publications

(29 citation statements)

References 90 publications

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“…A previous review summarized the economics of CDI treatments, but it did not include study quality assessments and based recommendations on partial costing or comparative effectiveness studies. 18 Therefore, the aim of this systematic review was to critically assess the available literature on economic evaluations of various treatment modalities for initial and recurrent CDI. Based on model comparison, we summarized the findings about treatment modalities and key issues for clinicians to consider when treating patients with CDI, to inform health policy makers, and to identify important areas for future cost-effectiveness research.…”

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confidence: 99%

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

Nghiem

Mullen³

et al. 2018

Infect. Control Hosp. Epidemiol.

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BACKGROUND Clostridium difficile infection (CDI) presents a substantial economic burden and is associated with significant morbidity. While multiple treatment strategies have been evaluated, a cost-effective management strategy remains unclear. OBJECTIVE We conducted a systematic review to assess cost-effectiveness analyses of CDI treatment and to summarize key issues for clinicians and policy makers to consider. METHODS We searched PubMed and 5 other databases from inception to August 2016. These searches were not limited by study design or language of publication. Two reviewers independently screened the literature, abstracted data, and assessed methodological quality using the Drummond and Jefferson checklist. We extracted data on study characteristics, type of CDI, treatment characteristics, and model structure and inputs. RESULTS We included 14 studies, and 13 of these were from high-income countries. More than 90% of these studies were deemed moderate-to-high or high quality. Overall, 6 studies used a decision-tree model and 7 studies used a Markov model. Cost of therapy, time horizon, treatment cure rates, and recurrence rates were common influential factors in the study results. For initial CDI, fidaxomicin was a more cost-effective therapy than metronidazole or vancomycin in 2 of 3 studies. For severe initial CDI, 2 of 3 studies found fidaxomicin to be the most cost-effective therapy. For recurrent CDI, fidaxomicin was cost-effective in 3 of 5 studies, while fecal microbiota transplantation (FMT) by colonoscopy was consistently cost-effective in 4 of 4 studies. CONCLUSIONS The cost-effectiveness of fidaxomicin compared with other pharmacologic therapies was not definitive for either initial or recurrent CDI. Despite its high cost, FMT by colonoscopy may be a cost-effective therapy for recurrent CDI. A consensus on model design and assumptions are necessary for future comparison of CDI treatment. Infect Control Hosp Epidemiol 2018;39:412-424.

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confidence: 99%

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

Nghiem

Mullen³

et al. 2018

Infect. Control Hosp. Epidemiol.

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“…The strict anaerobic and spore‐forming bacterium, Clostridium difficile , was originally isolated from stool of healthy infants by Hall and O'Toole , but only much later recognized as the cause of antibiotic‐associated pseudomembranous colitis . Nowadays, it represents the most common cause of hospital‐acquired diarrhea and an enormous financial burden for the health care system . The emergence of hypervirulent and antibiotic‐resistant strains as well as the high relapse rate associated with C. difficile infections necessitate novel, nonantibiotic‐based treatment strategies.…”

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The protein inventory of Clostridium difficile grown in complex and minimal medium

Otto

Maaß

Lassek

et al. 2016

Proteomics Clinical Apps

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The intestinal pathogen Clostridium difficile is causing an increasing number of infections often characterized by severity and high relapse rates. Profound knowledge of the physiology of the pathogen could help to develop new treatment strategies. Proteomics, a valuable tool to study bacterial physiology, was used in this work to establish a benchmark proteome of reference strain C. difficile 630Δerm with MS-based details on all identified proteins. Our elaborate annotation and visualization of C. difficile 630Δerm 3764 ORFs will serve as a valuable base for researchers having to evaluate global expression studies. To exemplify expression variability, protein expression of late exponentially growing cells in complex brain-heart infusion medium and C. difficile minimal medium was compared. Noteworthy results of this comparison are as follows: (i) the higher expression of enzymes for the biosynthesis of some vitamins and purine and (ii) downregulation of proteins involved in butanoate fermentation in C. difficile minimal medium. However, the abundance of proteins involved in DNA metabolism, protein synthesis, and the cell envelope showed no variation between the two growth media.

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“…3 The estimated attributable costs of CDI range from $3,197-$11,868 per case, with associated annual costs of $1-$3.6 billion. 4 A significant proportion of costs are attributed to the treatment of recurrent disease because approximately 25% of patients will have recurrence after initial cure. 5 Risk factors for recurrent C difficile infection (rCDI) are common among intensive care unit (ICU) patients and include antibiotic exposure, gastric acid suppression, increased contact with the health care system, advanced age, and impaired immune response.…”

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confidence: 99%