Economic burden and cost-effectiveness of therapies for <i>Clostridiodes difficile</i> infection: a narrative review

Gupta, Akshita; Ananthakrishnan, Ashwin N.

doi:10.1177/17562848211018654

Cited by 40 publications

(22 citation statements)

References 99 publications

(144 reference statements)

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“…Findings from multivariable regression analysis in this study suggest it was fidaxomicin use more so than the overall treatment pathway that increased sustained response pre-post, further highlighting the important contribution of fidaxomicin. Reductions in recurrences and CDI readmissions post treatment pathway implementation demonstrate real-world experience consistent with prior literature, with the current study also Median of 5 days used for both due to non-significant difference [6 (4-10) vs. 4.5 (2-4.5), p = 0.251] c Equals savings from CDI-related readmission costs/the additional number of patients with sustained response d Equals savings from CDI-related readmission costs/the number of CDI-related readmissions avoided e Equals savings from CDI-related readmission costs/the number of bed-days saved providing a larger sample-size than available retrospective studies [17][18][19].…”

Section: Discussionmentioning

confidence: 99%

Clinical and Economic Outcomes After Implementation of a Fidaxomicin Treatment Optimization and Access Pathway at a US Hospital System

et al. 2022

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Introduction This study aimed to evaluate the clinical and economic outcomes of implementing a Clostridiodes difficile infection (CDI) Treatment Optimization and Access Pathway (treatment pathway) directing first-line use of fidaxomicin for CDI. Methods This was a retrospective, quasi-experimental study of adult patients with CDI using Electronic Health Record data from a single center. The primary intervention was implementation of a treatment pathway directing first-line use of fidaxomicin for patients with first/second CDI episode and at high risk of recurrence. The primary clinical outcome was CDI recurrence within 30 days of completing therapy in patients achieving clinical cure. Secondary clinical outcomes included clinical cure and sustained response evaluated at 90 days after completion of CDI treatment. Economic outcomes included costs associated with hospital stay at index admission and 30- and 90-day readmission. Differences between the pre- and post-implementation cohorts were assessed for baseline characteristics, CDI treatment utilization, clinical outcomes, and economic outcomes. The budget impact was calculated for the pre- vs. post-implementation cohorts, each normalized to 100 patients. Results Post- vs. pre-implementation, 30-day recurrence (6.4% vs. 18.0%., p = 0.001), 90-day recurrence (14.9% vs. 27.1%, p = 0.009), and 30-day (4.6% vs. 12.7%, p = 0.007) and 90-day CDI-related readmissions (8.5% vs. 18.9%, p = 0.007) were lower. The clinical cure (94.1% vs. 84.4%, p = 0.002) and 90-day sustained response rates were higher (73.3% vs. 55.9%, p < 0.001). Median total costs were also lower in the post- vs. pre-implementation cohorts at index admission ($11,934.64 vs. $14,523.27, p = 0.048), and 30-day ($7685.82 vs. $12,424.44, p = 0.102) and 90-day CDI-related readmission episodes ($8246.69 vs. $12,729.57, p = 0.042). The budget impact analyses of 100 patients post- vs. pre-implementation found saving of $222,895 overall and $9432 per CDI-readmission avoided. Conclusions Implementation of the CDI treatment pathway was associated with better clinical outcomes and hospital cost savings. The findings help validate real-world value of fidaxomicin for CDI disease management.

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Section: Discussionmentioning

confidence: 99%

Clinical and Economic Outcomes After Implementation of a Fidaxomicin Treatment Optimization and Access Pathway at a US Hospital System

et al. 2022

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“…A nasoduodenal tube was chosen for delivery, as it was indicated that the small intestine is the main source of bacterial translocation in AP ( 27 ). From the point of cost-effectiveness, FMT contributed to shortening of ICU stay by 2 days, and 5 days of hospitalisation might be important for saving medical costs and social costs ( 28 , 29 ). Further multi-centre studies are needed to confirm our findings.…”

Section: Discussionmentioning

confidence: 99%

Efficacy and Safety of Faecal Microbiota Transplantation for Acute Pancreatitis: A Randomised, Controlled Study

Ding

et al. 2022

Front. Med.

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Aims: We investigated whether faecal microbiota transplantation (FMT) decreases intra-abdominal pressure (IAP) and improves gastrointestinal (GI) dysfunction and infectious complications in acute pancreatitis (AP).Methods: In this first randomised, single-blind, parallel-group, controlled study, we recruited and enrolled consecutive patients with AP complicated with GI dysfunction. Eligible participants were randomly assigned to receive faecal transplant (n = 30) or normal saline (n = 30) via a nasoduodenal tube once and then again 2 days later. The primary endpoint was the rate of IAP decline; secondary endpoints were GI function, infectious complications, organ failure, hospital stay and mortality. Analyses were based on intention to treat.Results: We enrolled 60 participants and randomly assigned them to the FMT (n = 30) or control (n = 30) group. Baseline characteristics and disease severity were similar for both groups. IAP decreased significantly 1 week after intervention in both groups, with no difference in the IAP decline rate between FMT and Control group [0.1 (−0.6, 0.5) vs. 0.2 (−0.2, 0.6); P = 0.27]. Normal gastrointestinal failure (GIF) scores were achieved in 12 (40%) patients in the FMT group and 14 (47%) in the control group, with no significant difference (P = 0.60). However, D-lactate was significantly elevated in the FMT group compared to the control group, as calculated by the rate of decline [−0.3 (−3.7, 0.8) vs. 0.4 (−1.1, 0.9); P = 0.01]. Infectious complications occurred in 15 (50%) and 16 (53.33%) patients in the FMT and control groups, respectively (P = 0.80). However, interleukin-6 (IL-6) was significantly elevated in the FMT group compared to the control group, as calculated by the rate of decline [0.4 (−3.6, 0.9) vs. 0.8 (−1.7, 1.0); P = 0.03]. One participant experienced transient nausea immediately after FMT, but no serious adverse events were attributed to FMT.Conclusion: FMT had no obvious effect on IAP and infectious complications in AP patients, though GI barrier indictors might be adversely affected. Further multi-centre studies are needed to confirm our findings. The study was registered at https://clinicaltrials.gov (NCT02318134).

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“…The only cost-effectiveness analysis is related to the comparison of the effect of fidaxomicin with standard therapy plus bezlotoxumab as reported by Lam et al focusing only on rCDI (237). Additionally, it is proven that fidaxomicin plus bezlotoxumab has similar effect to other SOC antibiotics (i.e., vancomycin or metronidazole) plus bezlotoxumab (42,238,239). Notably, pharmacoeconomic analyses demonstrate that standard therapy plus bezlotoxumab could be cost-effective compared with standard therapy alone, especially in preventing of rCDI episodes in those >65 years of age, those with severe CDI, and immunocompromised patients (234,237,(240)(241)(242)(243).…”

Section: Bezlotoxumab: the First Fda-approved Therapeutic Monoclonal ...mentioning

confidence: 99%

Application of recombinant antibodies for treatment of Clostridioides difficile infection: Current status and future perspective

et al. 2022

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Clostridioides difficile (C. difficile), known as the major cause of antibiotic-associated diarrhea, is regarded as one of the most common healthcare-associated bacterial infections worldwide. Due to the emergence of hypervirulent strains, development of new therapeutic methods for C. difficile infection (CDI) has become crucially important. In this context, antibodies have been introduced as valuable tools in the research and clinical environments, as far as the effectiveness of antibody therapy for CDI was reported in several clinical investigations. Hence, production of high-performance antibodies for treatment of CDI would be precious. Traditional approaches of antibody generation are based on hybridoma technology. Today, application of in vitro technologies for generating recombinant antibodies, like phage display, is considered as an appropriate alternative to hybridoma technology. These techniques can circumvent the limitations of the immune system and they can be exploited for production of antibodies against different types of biomolecules in particular active toxins. Additionally, DNA encoding antibodies is directly accessible in in vitro technologies, which enables the application of antibody engineering in order to increase their sensitivity and specificity. Here, we review the application of antibodies for CDI treatment with an emphasis on recombinant fragment antibodies. Also, this review highlights the current and future prospects of the aforementioned approaches for antibody-mediated therapy of CDI.

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Economic burden and cost-effectiveness of therapies for Clostridiodes difficile infection: a narrative review

Cited by 40 publications

References 99 publications

Clinical and Economic Outcomes After Implementation of a Fidaxomicin Treatment Optimization and Access Pathway at a US Hospital System

Clinical and Economic Outcomes After Implementation of a Fidaxomicin Treatment Optimization and Access Pathway at a US Hospital System

Efficacy and Safety of Faecal Microbiota Transplantation for Acute Pancreatitis: A Randomised, Controlled Study

Application of recombinant antibodies for treatment of Clostridioides difficile infection: Current status and future perspective

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