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

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

doi:10.1111/1469-0691.12805

Cited by 41 publications

(67 citation statements)

References 56 publications

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“…Endoscopic delivery carries some procedural risk and increases health care utilization and costs, though a cost-effectiveness study showed FMT dominated (i.e. was less costly and more effective) than vancomycin for initial CDI 42 . FMT is reported to be effective by all of these routes, and the preferred method may vary with the clinical situation.…”

Section: Current Treatment Guidelines and Methodsmentioning

confidence: 99%

Update on Fecal Microbiota Transplantation 2015: Indications, Methodologies, Mechanisms, and Outlook

et al. 2015

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The community of microorganisms within the human gut (or microbiota) is critical to health and functions with a level of complexity comparable to an organ system. Alterations of this ecology (or dysbiosis) has been implicated in a number of disease states, the prototypical example being Clostridium difficile infection (CDI). Fecal microbiota transplantation (FMT) has been demonstrated to durably alter the gut microbiota of the recipient and has shown efficacy in the treatment of recurrent CDI. There is hope that FMT may eventually prove beneficial for treatment of other disease associated with alterations in gut microbiota, such as inflammatory bowel disease, irritable bowel syndrome and the metabolic syndrome, to name a few. Although the basic principles that underlie the mechanisms by which FMT demonstrates therapeutic efficacy in CDI are becoming apparent, further research is needed to understand the possible role of FMT in these other conditions. Though relatively simple to perform, questions regarding both short- and long-term safety, as well as the complex and rapidly evolving regulatory landscape has limited widespread utilization. Future work will focus on establishing best practices and more robust safety data than exist currently, as well as refining FMT beyond current “whole stool” transplants to increase safety and tolerability. Encapsulated formulations, full spectrum stool-based products and defined microbial consortia are all in the immediate future.

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Section: Current Treatment Guidelines and Methodsmentioning

confidence: 99%

Update on Fecal Microbiota Transplantation 2015: Indications, Methodologies, Mechanisms, and Outlook

et al. 2015

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“…In published cost-effectiveness studies of oral vancomycin in the United States, the per-dose cost varies from $5 to $33 [2, 10]. Although it almost uniformly overestimates true acquisition costs, average wholesale price (AWP) is the only published reference that has been available for several years as a means of comparing vancomycin costs over time (Table 1).…”

Section: Cost Of Oral Vancomycinmentioning

confidence: 99%

Economic Barriers in the Treatment of Clostridium difficile Infection With Oral Vancomycin

Bunnell

Danziger

Johnson

2017

Open Forum Infectious Diseases

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Vancomycin is an increasingly important option for the treatment of Clostridium difficile infection, but economic barriers to its use remain significant in the outpatient setting. Generic vancomycin capsules are still inexplicably expensive and not universally covered by insurers. This report highlights the potential adverse consequences of cost-related nonadherence to vancomycin therapy and the challenges that clinicians face when prescribing oral vancomycin.

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“…Interestingly, endoscopic FMT is more cost-effective than treatment with vancomycin for initial CDI. 92 …”

Section: Fecal Microbiota Transplantmentioning

confidence: 99%

Clostridium difficile Infection and Fecal Microbiota Transplant

Liubakka

Vaughn

2016

AACN Advanced Critical Care

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Clostridium difficile infection (CDI) is a major source of morbidity and mortality for hospitalized patients. Although most patients have a clinical response to existing antimicrobial therapies, recurrent infection develops in up to 30% of patients. Fecal microbiota transplant is a novel approach to this complex problem, with an efficacy rate of nearly 90% in the setting of multiple recurrent CDI. This review covers the current epidemiology of CDI (including toxigenic and nontoxigenic strains, risk factors for infection, and recurrent infection), methods of diagnosis, existing first-line therapies in CDI, the role of fecal microbiota transplant for multiple recurrent CDIs, and the potential use of fecal microbial transplant for patients with severe or refractory infection.

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

Cited by 41 publications

References 56 publications

Update on Fecal Microbiota Transplantation 2015: Indications, Methodologies, Mechanisms, and Outlook

Update on Fecal Microbiota Transplantation 2015: Indications, Methodologies, Mechanisms, and Outlook

Economic Barriers in the Treatment of Clostridium difficile Infection With Oral Vancomycin

Clostridium difficile Infection and Fecal Microbiota Transplant

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