Journal Article

Cost-effectiveness of Treatment Regimens for Clostridioides difficile Infection

Rajasingham, Radha, Khoruts, Alexander, Enns, Eva A., Vaughn, Byron P.

2020

Overview

Abstract Background In 2018, the Infectious Diseases Society of America (IDSA) published guidelines for diagnosis and treatment of Clostridioides (formerly Clostridium) difficile infection (CDI). However, there is little guidance regarding which treatments are cost-effective. Methods We used a Markov model to simulate a cohort of patients presenting with an initial CDI diagnosis. We used the model to estimate the costs, effectiveness, and cost-effectiveness of different CDI treatment regimens recommended in the recently published 2018 IDSA guidelines. The model includes stratification by the severity of the initial infection, and subsequent likelihood of cure, recurrence, mortality, and outcomes of subsequent recurrences. Data sources were taken from IDSA guidelines and published literature on treatment outcomes. Outcome measures were discounted quality-adjusted life-years (QALYs), costs, and incremental cost-effectiveness ratios (ICERs). Results Use of fidaxomicin for nonsevere initial CDI, vancomycin for severe CDI, fidaxomicin for first recurrence, and fecal microbiota transplantation (FMT) for subsequent recurrence (strategy 44) cost an additional $478 for 0.009 QALYs gained per CDI patient, resulting in an ICER of $31 751 per QALY, below the willingness-to-pay threshold of $100 000/QALY. This is the optimal, cost-effective CDI treatment strategy. Conclusions Metronidazole is suboptimal for nonsevere CDI as it is less beneficial than alternative strategies. The preferred treatment regimen is fidaxomicin for nonsevere CDI, vancomycin for severe CDI, fidaxomicin for first recurrence, and FMT for subsequent recurrence. The most effective treatments, with highest cure rates, are also cost-effective due to averted mortality, utility loss, and costs of rehospitalization and/or further treatments for recurrent CDI. We estimated the cost-effectiveness of different treatment regimens for Clostridioides difficile infection (CDI), per Infectious Diseases Society of America 2018 guidelines. Optimal treatment is vancomycin for severe CDI, fidaxomicin for first recurrence, and fecal microbiota transplant for subsequent recurrence.

• Publisher: Oxford University Press
• Subject: and Commentaries / Anti-Bacterial Agents - therapeutic use / ARTICLES AND COMMENTARIES / Clostridioides / Clostridioides difficile / Clostridium Infections - diagnosis / Clostridium Infections - drug therapy / Communicable Diseases - drug therapy / Cost-Benefit Analysis / Humans / Recurrence