Cost-Effectiveness Analysis of Fecal Microbiota Transplantation for Recurrent <i>Clostridium difficile</i> Infection

Varier, Raghu; Biltaji, Eman; Smith, Kenneth J.; Roberts, Mark S.; Jensen, M. Kyle; LaFleur, Joanne; Nelson, Richard E.

doi:10.1017/ice.2014.80

Cited by 65 publications

(69 citation statements)

References 42 publications

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“…Similar results have been demonstrated by other economic analyses evaluating FMT for treatment of recurrent CDI [10,14,15]. A cost-effectiveness analysis of strategies for treatment of recurrent CDI performed from a societal perspective in the USA concluded that FMT via colonoscopy was cost-effective with an ICER of $17,016 compared with vancomycin at a willingness-to-pay threshold of $50,000/QALY [10].…”

Section: Discussionsupporting

confidence: 75%

“…Another study by Varier et al compared vancomycin with FMT for recurrent CDI from a third-party payer perspective using U.S. data. Even though the authors accounted for adverse events of colonoscopy, they found that FMT administered via colonoscopy was both less costly and more effective than prolonged oral vancomycin taper at all willingness-to-pay thresholds based on the probabilistic sensitivity analysis [14]. …”

Section: Discussionmentioning

confidence: 99%

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

et al. 2017

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BackgroundClostridium difficile infection (CDI) is characterized by high rates of recurrence, resulting in substantial health care costs. The aim of this study was to analyze the cost-effectiveness of treatments for the management of second recurrence of community-onset CDI in France.MethodsWe developed a decision-analytic simulation model to compare 5 treatments for the management of second recurrence of community-onset CDI: pulsed-tapered vancomycin, fidaxomicin, fecal microbiota transplantation (FMT) via colonoscopy, FMT via duodenal infusion, and FMT via enema. The model outcome was the incremental cost-effectiveness ratio (ICER), expressed as cost per quality-adjusted life year (QALY) among the 5 treatments. ICERs were interpreted using a willingness-to-pay threshold of €32,000/QALY. Uncertainty was evaluated through deterministic and probabilistic sensitivity analyses.ResultsThree strategies were on the efficiency frontier: pulsed-tapered vancomycin, FMT via enema, and FMT via colonoscopy, in order of increasing effectiveness. FMT via duodenal infusion and fidaxomicin were dominated (i.e. less effective and costlier) by FMT via colonoscopy and FMT via enema. FMT via enema compared with pulsed-tapered vancomycin had an ICER of €18,092/QALY. The ICER for FMT via colonoscopy versus FMT via enema was €73,653/QALY. Probabilistic sensitivity analysis with 10,000 Monte Carlo simulations showed that FMT via enema was the most cost-effective strategy in 58% of simulations and FMT via colonoscopy was favored in 19% at a willingness-to-pay threshold of €32,000/QALY.ConclusionsFMT via enema is the most cost-effective initial strategy for the management of second recurrence of community-onset CDI at a willingness-to-pay threshold of €32,000/QALY.

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Section: Discussionsupporting

confidence: 75%

Section: Discussionmentioning

confidence: 99%

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

et al. 2017

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“…Although excluding costs of treatment-related adverse events would bias results, only 3 studies included such costs. 15,16,31 Most studies used official sources for cost estimates, and US studies had higher per-unit costs than studies in other countries. The cost of FMT therapy varied depending on the route of administration and often included associated pretreatment cost of oral vancomycin.…”

Section: Resultsmentioning

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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“…[1][2][3][4][5][6][7] Due to the rising prevalence, severity and mortality of this infection, the therapeutic role played by FMT is therefore important to save human lives and to decrease the economic burden on healthcare systems. [8][9][10][11] Based on these data, both the European Society for Microbiology and Infectious Disease and the American College of Gastroenterology recommend FMT as a treatment for rCDI. 12 13 Beyond the treatment of CDI, FMT has also been investigated in other disorders associated with the alteration of gut microbiota.…”

Section: Introductionmentioning

confidence: 99%

European consensus conference on faecal microbiota transplantation in clinical practice

Cammarota

Ianiro

Tilg

et al. 2017

Gut

875

848

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Faecal microbiota transplantation (FMT) is an important therapeutic option for Clostridium difficile infection. Promising findings suggest that FMT may play a role also in the management of other disorders associated with the alteration of gut microbiota. Although the health community is assessing FMT with renewed interest and patients are becoming more aware, there are technical and logistical issues in establishing such a non-standardised treatment into the clinical practice with safety and proper governance. In view of this, an evidence-based recommendation is needed to drive the practical implementation of FMT. In this European Consensus Conference, 28 experts from 10 countries collaborated, in separate working groups and through an evidence-based process, to provide statements on the following key issues: FMT indications; donor selection; preparation of faecal material; clinical management and faecal delivery and basic requirements for implementing an FMT centre. Statements developed by each working group were evaluated and voted by all members, first through an electronic Delphi process, and then in a plenary consensus conference. The recommendations were released according to best available evidence, in order to act as guidance for physicians who plan to implement FMT, aiming at supporting the broad availability of the procedure, discussing other issues relevant to FMT and promoting future clinical research in the area of gut microbiota manipulation. This consensus report strongly recommends the implementation of FMT centres for the treatment of C. difficile infection as well as traces the guidelines of technicality, regulatory, administrative and laboratory requirements.

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Cost-Effectiveness Analysis of Fecal Microbiota Transplantation for Recurrent Clostridium difficile Infection

Abstract: Our results suggest that FMT may be a cost-saving intervention in managing RCDI. Implementation of FMT for RCDI may help decrease the economic burden to the healthcare system.

Cited by 65 publications

References 42 publications

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

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

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

European consensus conference on faecal microbiota transplantation in clinical practice

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