Recurrent &lt;i&gt;Clostridium difficile-&lt;/i&gt;Associated Colitis Responding to Cholestyramine

Kunimoto, Derek; Thomson, A. D.

doi:10.1159/000199299

Cited by 28 publications

(11 citation statements)

References 9 publications

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“…Some studies support the use of intravenous immunoglobulin, probiotics, cholestyramine, or fidaxomicin in RCDI, though the evidence is deemed marginal. [5][6][7][8][9]37 Economically dominant interventions, such as FMT versus vancomycin, are relatively uncommon in health care. Therefore, finding an intervention that is clinically effective and also cost saving supports its implementation as a potential first line modality.…”

Section: Discussionmentioning

confidence: 99%

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

Varier

Biltaji

Smith

et al. 2015

Infect. Control Hosp. Epidemiol.

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Section: Discussionmentioning

confidence: 99%

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

Varier

Biltaji

Smith

et al. 2015

Infect. Control Hosp. Epidemiol.

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“…Fecal samples from patients with recurrent CDI have increased concentrations of primary bile salts and undetectable amounts of secondary bile acids, whereas FMT quickly restores a donor-like composition of fecal bile acid. 59 Interestingly, cholestyramine has been successful in anecdotal reports of treatment for recurrent CDI, 60-62 although it was not found to effectively treat primary CDI—possibly because it also stimulates bile acid synthesis and binds to vancomycin. 63-66 …”

Section: Introductionmentioning

confidence: 99%

From Stool Transplants to Next-Generation Microbiota Therapeutics

2014

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The epidemic of Clostridium difficile infection fueled by new virulent strains of the organism has led to increased use of fecal microbiota transplantation (FMT). The procedure is effective for even the most desperate cases, after failure of multiple courses of antibiotics. The approach recognizes microbiota to be integral to normal human physiology, and microbiota being used in FMT represents a new class of therapeutics. Imbalance in the composition and altered activity of the microbiota are associated with many diseases. Consequently, there is growing interest in applying FMT to non-C. difficile indications. However, this may succeed only if microbiota therapeutics are developed systematically, based on mechanistic understanding, and applying updo-date principles of microbial ecology. We discuss two pathways in development of this new therapeutic class: whole microbial communities separated from donor stool and an assembly of specific fecal microorganisms grown in vitro.

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“…However, our model shows that vancomycin was both more expensive and less effective than FMT in patients with initial CDI. We chose not to include additional intervention strategies in our model, such as intravenous immunoglobulin, probiotics, cholestyramine or fidaxomicin, because there is little evidence to suggest that these are viable treatment options for initial CDI [5,[10][11][12][13]51].…”

Section: Discussionmentioning

confidence: 99%

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

Varier

Biltaji

Smith

et al. 2014

Clinical Microbiology and Infection

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Clostridium difficile infection (CDI) is costly. Current guidelines recommend metronidazole as first-line therapy and vancomycin as an alternative. Recurrence is common. Faecal microbiota transplantation (FMT) is an effective therapy for recurrent CDI (RCDI). This study explores the cost-effectiveness of FMT, vancomycin and metronidazole for initial CDI. We constructed a decision-analytic computer simulation using inputs from published literature to compare FMT with a 10-14-day course of oral metronidazole or vancomycin for initial CDI. Parameters included cure rates (baseline value (range)) for metronidazole (80% (65-85%)), vancomycin (90% (88-92%)) and FMT(91% (83-100%)). Direct costs of metronidazole, vancomycin and FMT, adjusted to 2011 dollars, were $57 ($43-72), $1347 ($1195-1499) and $1086 ($815-1358), respectively. Our effectiveness measure was quality-adjusted life years (QALYs). One-way and probabilistic sensitivity analyses were conducted from the third-party payer perspective. Analysis using baseline values showed that FMT($1669, 0.242 QALYs) dominated (i.e. was less costly and more effective) vancomycin ($1890, 0.241 QALYs). FMT was more costly and more effective than metronidazole ($1167, 0.238 QALYs), yielding an incremental cost-effectiveness ratio (ICER) of $124 964/QALY. One-way sensitivity analyses showed that metronidazole dominated both strategies if its probability of cure were >90%; FMT dominated if it cost <$584. In a probabilistic sensitivity analysis at a willingness-to-pay threshold of $100 000/QALY, metronidazole was favoured in 55% of model iterations; FMT was favoured in 38%. Metronidazole, as the first-line treatment for CDIs, is less costly. FMT and vancomycin are more effective. However, FMT is less likely to be economically favourable, and vancomycin is unlikely to be favourable as first-line therapy when compared with FMT.

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Recurrent <i>Clostridium difficile-</i>Associated Colitis Responding to Cholestyramine

Cited by 28 publications

References 9 publications

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

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

From Stool Transplants to Next-Generation Microbiota Therapeutics

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

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