Fecal Transplants by Colonoscopy and Capsules Are Cost-Effective Strategies for Treating Recurrent Clostridioides difficile Infection

Luo, Yuying; Lucas, Aimee L.; Grinspan, Ari

doi:10.1007/s10620-019-05821-1

Cited by 17 publications

(31 citation statements)

References 43 publications

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“…The low cure rate of vancomycin in high‐risk patients subsequently led to increased utilization of health‐care resources for management of refractory cases and higher total cost in the vancomycin group. Our results were also consistent to the outcome measures of a decision model‐based cost‐effectiveness analysis on FMT, vancomycin with bezlotoxumab and fidaxomicin for community‐dwelling elderly patients with first RCDI in the United States . Both the U.S. and present analyses found the FMT to be the least costly and most effective strategy.…”

Section: Discussionsupporting

confidence: 82%

Cost‐effectiveness analysis of fecal microbiota transplantation for recurrent Clostridium difficile infection in patients with inflammatory bowel disease

You

Jiang

Lee

et al. 2020

J of Gastro and Hepatol

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Background and Aim: Inflammatory bowel disease (IBD) patients are at risk for recurrent Clostridium difficile infection (RCDI). We aimed to evaluate the potential health economic and clinical outcomes of four strategies for management of RCDI in IBD patients from the perspective of public health-care provider in Hong Kong. Methods: A decision-analytic model was designed to simulate outcomes of adult IBD patients with first RCDI treated with vancomycin, vancomycin plus bezlotoxumab, fidaxomicin and fecal microbiota transplantation (FMT). Model inputs were derived from literature and public data. Primary model outcomes were C. difficile infection (CDI)-related direct medical cost and quality-adjusted life-years (QALYs) loss. Base-case and sensitivity analysis were performed. Results: Comparing to vancomycin, fidaxomicin and vancomycin plus bezlotoxumab, FMT saved 0.00318, 0.00149 and 0.00306 QALYs and reduced cost by USD3180, USD3790 and USD5514, respectively, in base-case analysis. In probabilistic sensitivity analysis, FMT was cost-saving when comparing to vancomycin, fidaxomicin and vancomycin plus bezlotoxumab by USD3765 (95% confidence interval [CI] 3732-3798; P < 0.001), USD3854 (95%CI 3827-3883; P < 0.001) and USD6501 (95%CI 6465-6,536; P < 0.001), respectively. The QALYs saved by FMT (vs vancomycin) were 0.00386 QALYs (95%CI 0.00384-0.00388; P < 0.001), (vs fidaxomicin) 0.00179 QALYs (95%CI 0.00177-0.00180; P < 0.001) and (vs vancomycin plus bezlotoxumab) 0.00376 QALYs (95%CI 0.00374-0.00378; P < 0.001). FMT was found to save QALYs at lower cost in 99.3% (vs vancomycin), 99.7% (vs fidaxomicin) and 100.0% (vs vancomycin plus bezlotoxumab) of the 10 000 Monte Carlo simulations. Conclusions: FMT for IBD patients with RCDI appeared to save both direct medical cost and QALYs when comparing to vancomycin (with or without bezlotoxumab) and fidaxomicin.

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Section: Discussionsupporting

confidence: 82%

Cost‐effectiveness analysis of fecal microbiota transplantation for recurrent Clostridium difficile infection in patients with inflammatory bowel disease

You

Jiang

Lee

et al. 2020

J of Gastro and Hepatol

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“…Among these, 207 were excluded as they were not full health economic evaluations, did not compare FMT with antibiotic treatment or did not focus on rCDI. Thus, the full text of a total of 14 records was screened, and seven of these were included in the systematic review [24][25][26][27][28][29][30].…”

Section: Study Selectionmentioning

confidence: 99%

“…The studies originated from the United States (n = 3) [24,25,29], Canada (n = 1) [26], Australia (n = 1) [27], France (n = 1) [28] and the United Kingdom (n = 1) [30] and were published between 2014 and 2020. All studies were cost-utility analyses based on decision-analytic modelling using either decision trees (n = 4) [24,25,28,29] or Markov models (n = 3) [26,27,30]. The number of previous rCDI episodes differed between studies, ranging from the first to the third rCDI at inclusion.…”

Section: Study Characteristicsmentioning

confidence: 99%

“…All studies included FMT administered by colonoscopy, and some also included nasoduodenal/−gastric infusion (n = 5) [24,[26][27][28]30], enema (n = 3) [24,26,28] or oral capsules (n = 1) [29]. The treatment of additional recurrences was either reported as repeat FMT or a shift to oral vancomycin.…”

Section: Study Characteristicsmentioning

confidence: 99%

“…In all studies, the control treatment was oral vancomycin in different dosages and treatment regimens. Fidaxomicin was applied in most studies (n = 5) [24,26,[28][29][30], whereas two studies included oral metronidazole [24,26], and one study included the combination of oral vancomycin with bezlotoxumab [29]. In case of additional recurrences, the subsequent antibiotic treatment strategies differed in accordance with the number of previous rCDI episodes.…”

Section: Study Characteristicsmentioning

confidence: 99%

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Health economic evaluations comparing faecal microbiota transplantation with antibiotics for treatment of recurrent Clostridioides difficile infection: a systematic review

et al. 2021

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Background Faecal microbiota transplantation (FMT) is increasingly being used in the treatment of recurrent Clostridioides difficile infection (rCDI). Health economic evaluations may support decision-making regarding the implementation of FMT in clinical practice. Previous reviews have highlighted several methodological concerns in published health economic evaluations examining FMT. However, the impact of these concerns on the conclusions of the studies remains unclear. Aims To present an overview and assess the methodological quality of health economic evaluations that compare FMT with antibiotics for treatment of rCDI. Furthermore, we aimed to evaluate the degree to which any methodological concerns would affect conclusions about the cost-effectiveness of FMT. Methods We conducted a systematic literature review based on a search in seven medical databases up to 16 July 2020. We included research articles reporting on full health economic evaluations comparing FMT with antibiotic treatment for rCDI. General study characteristics and input estimates for costs, effectiveness and utilities were extracted from the articles. The quality of the studies was assessed by two authors using the Drummonds ten-point checklist. Results We identified seven cost-utility analyses. All studies applied decision-analytic modelling and compared various FMT delivery methods with vancomycin, fidaxomicin, metronidazole or a combination of vancomycin and bezlotoxumab. The time horizons used in the analyses varied from 78 days to lifelong, and the perspectives differed between a societal, a healthcare system or a third-party payer perspective. The applied willingness-to-pay threshold ranged from 20,000 to 68,000 Great Britain pound sterling (GBP) per quality-adjusted life-year (QALY). FMT was considered the most cost-effective alternative in all studies. In five of the health economic evaluations, FMT was both more effective and cost saving than antibiotic treatment alternatives. The quality of the articles varied, and we identified several methodological concerns. Conclusions Economic evaluations consistently reported that FMT is a cost-effective and potentially cost-saving treatment for rCDI. Based on a comparison with recent evidence within the area, the multiple methodological concerns seem not to change this conclusion. Therefore, implementing FMT for rCDI in clinical practice should be strongly considered.

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The Importance of the Microbiome in the Gut

Morrison,

Murtaza,

Talley

2023

Clinical Understanding of the Human Gut Microbiome

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Fecal Transplants by Colonoscopy and Capsules Are Cost-Effective Strategies for Treating Recurrent Clostridioides difficile Infection

Cited by 17 publications

References 43 publications

Cost‐effectiveness analysis of fecal microbiota transplantation for recurrent Clostridium difficile infection in patients with inflammatory bowel disease

Cost‐effectiveness analysis of fecal microbiota transplantation for recurrent Clostridium difficile infection in patients with inflammatory bowel disease

Health economic evaluations comparing faecal microbiota transplantation with antibiotics for treatment of recurrent Clostridioides difficile infection: a systematic review

The Importance of the Microbiome in the Gut

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