Cost-Effectiveness Comparison of Fidaxomicin and Vancomycin for Treatment of Clostridium difficile Infection: A Markov Model Based on Data from a South West Balkan Country in Socioeconomic Transition

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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“…13 Another study did not specify the perspective, 26 and 2 studies lacked information on cost year. 28,29 …”

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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“…The most common treatment comparison was between fidaxomicin and vancomycin only, reported in 14 EEs [ 26 – 28 , 36 , 39 , 40 , 42 , 43 , 50 , 56 , 58 , 60 , 64 ]. Five EEs [ 37 , 47 , 49 , 57 , 62 ] compared fidaxomicin with vancomycin and metronidazole.…”

Section: Resultsmentioning

confidence: 99%

“…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.…”

Section: Resultsmentioning

confidence: 99%

“…These included the USA (11 EEs [ 28 , 36 , 37 , 42 , 44 , 46 , 49 , 51 , 54 , 59 , 65 ]), Canada (three EEs [ 48 , 55 ]), the UK (two EEs [ 26 , 57 ]) and Germany (two EEs [ 27 , 43 ]). Overall, 24 of the EEs were conducted from a payer perspective [ 26 – 28 , 36 , 37 , 39 , 40 , 42 , 44 , 47 – 50 , 54 – 60 , 62 , 64 , 65 ] and three [ 43 , 46 , 51 ] were conducted from a societal perspective.…”

Section: Resultsmentioning

confidence: 99%

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

Burton¹,

Mitchell²,

Watt

2017

PharmacoEconomics

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Background and Objective Clostridium difficile infection (CDI) is associated with high management costs, particularly in recurrent cases. Fidaxomicin treatment results in lower recurrence rates than vancomycin and metronidazole, but has higher acquisition costs in Europe and the USA. This systematic literature review summarises economic evaluations (EEs) of fidaxomicin, vancomycin and metronidazole for treatment of CDI.MethodsElectronic databases (MEDLINE®, Embase, Cochrane Library) and conference proceedings (ISPOR, ECCMID, ICAAC and IDWeek) were searched for publications reporting EEs of fidaxomicin, vancomycin and/or metronidazole in the treatment of CDI. Reference bibliographies of identified manuscripts were also reviewed. Cost-effectiveness was evaluated according to the overall population of patients with CDI, as well as in subgroups with severe CDI or recurrent CDI, or those at higher risk of recurrence or mortality.ResultsOverall, 27 relevant EEs, conducted from the perspective of 12 different countries, were identified. Fidaxomicin was cost-effective versus vancomycin and/or metronidazole in 14 of 24 EEs (58.3%), vancomycin was cost-effective versus fidaxomicin and/or metronidazole in five of 27 EEs (18.5%) and metronidazole was cost-effective versus fidaxomicin and/or vancomycin in two of 13 EEs (15.4%). Fidaxomicin was cost-effective versus vancomycin in most of the EEs evaluating specific patient subgroups. Key cost-effectiveness drivers were cure rate, recurrence rate, time horizon, drug costs and length and cost of hospitalisation.ConclusionsIn most EEs, fidaxomicin was demonstrated to be cost-effective versus metronidazole and vancomycin in patients with CDI. These results have relevance to clinical practice, given the high budgetary impact of managing CDI and increasing restrictions on healthcare budgets.OtherThis analysis was initiated and funded by Astellas Pharma Inc.Electronic supplementary materialThe online version of this article (doi:10.1007/s40273-017-0540-2) contains supplementary material, which is available to authorized users.

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“…The latter is supported by the evidence from systematic review of economic evaluation of antimicrobial therapy for CDI by Burton HE et al, indicating that fidaxomicin could have a better cost-effectiveness ratio then other antibiotics for CDI treatment in patients with highrisk of complicated and recurrent CDI, when the majority of pharmacoeconomic outcomes were taken into account 18 . As an example, the study that was carried out in Serbia, a country passing throughout socioeconomic transition where the fidaxomicin has not been approved yet, suggests this drug could be more cost-effective option in patients refractory to metronidazole monotherapy in comparison to vancomycin, since it saves more lives, but does not avoid colectomies; this comparative advantage could be especially obvious in patients with the recurrent infection that must continue to use systemic antibiotics, particularly if free-market prices of health services in Serbia are allowed 19 .…”

Section: Antimicrobial Therapy Of CDImentioning

confidence: 99%

Modern approach to the therapy of infections caused by Clostridium difficile

Jaćović¹,

Milisavljević²,

Milosavljević³

et al. 2018

Racion ter

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Cost-Effectiveness Comparison of Fidaxomicin and Vancomycin for Treatment of Clostridium difficile Infection: A Markov Model Based on Data from a South West Balkan Country in Socioeconomic Transition

Cited by 9 publications

References 32 publications

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

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

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

Modern approach to the therapy of infections caused by Clostridium difficile

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