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Cost-Effectiveness Analysis of Six Strategies to Treat Recurrent Clostridium difficile Infection

Author

Listed:
  • Lauren Lapointe-Shaw
  • Kim L Tran
  • Peter C Coyte
  • Rebecca L Hancock-Howard
  • Jeff Powis
  • Susan M Poutanen
  • Susy Hota

Abstract

Objective: To assess the cost-effectiveness of six treatment strategies for patients diagnosed with recurrent Clostridium difficile infection (CDI) in Canada: 1. oral metronidazole; 2. oral vancomycin; 3.oral fidaxomicin; 4. fecal transplantation by enema; 5. fecal transplantation by nasogastric tube; and 6. fecal transplantation by colonoscopy. Perspective: Public insurer for all hospital and physician services. Setting: Ontario, Canada. Methods: A decision analytic model was used to model costs and lifetime health effects of each strategy for a typical patient experiencing up to three recurrences, over 18 weeks. Recurrence data and utilities were obtained from published sources. Cost data was obtained from published sources and hospitals in Toronto, Canada. The willingness-to-pay threshold was $50,000/QALY gained. Results: Fecal transplantation by colonoscopy dominated all other strategies in the base case, as it was less costly and more effective than all alternatives. After accounting for uncertainty in all model parameters, there was an 87% probability that fecal transplantation by colonoscopy was the most beneficial strategy. If colonoscopy was not available, fecal transplantation by enema was cost-effective at $1,708 per QALY gained, compared to metronidazole. In addition, fecal transplantation by enema was the preferred strategy if the probability of recurrence following this strategy was below 8.7%. If fecal transplantation by any means was unavailable, fidaxomicin was cost-effective at an additional cost of $25,968 per QALY gained, compared to metronidazole. Conclusion: Fecal transplantation by colonoscopy (or enema, if colonoscopy is unavailable) is cost-effective for treating recurrent CDI in Canada. Where fecal transplantation is not available, fidaxomicin is also cost-effective.

Suggested Citation

  • Lauren Lapointe-Shaw & Kim L Tran & Peter C Coyte & Rebecca L Hancock-Howard & Jeff Powis & Susan M Poutanen & Susy Hota, 2016. "Cost-Effectiveness Analysis of Six Strategies to Treat Recurrent Clostridium difficile Infection," PLOS ONE, Public Library of Science, vol. 11(2), pages 1-18, February.
    • Handle: RePEc:plo:pone00:0149521
    DOI: 10.1371/journal.pone.0149521
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    References listed on IDEAS

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    2. Leyla Mohseninejad & Talitha Feenstra & Henriëtte Horst & Hèlen Woutersen-Koch & Erik Buskens, 2013. "Targeted screening for Coeliac Disease among irritable bowel syndrome patients: analysis of cost-effectiveness and value of information," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 14(6), pages 947-957, December.
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    1. Emilie Baro & Tatiana Galperine & Fanette Denies & Damien Lannoy & Xavier Lenne & Pascal Odou & Benoit Guery & Benoit Dervaux, 2017. "Cost-Effectiveness Analysis of Five Competing Strategies for the Management of Multiple Recurrent Community-Onset Clostridium difficile Infection in France," PLOS ONE, Public Library of Science, vol. 12(1), pages 1-15, January.
    2. Minghuan Jiang & Nok-hang Leung & Margaret Ip & Joyce H S You, 2018. "Cost-effectiveness analysis of ribotype-guided fecal microbiota transplantation in Chinese patients with severe Clostridium difficile infection," PLOS ONE, Public Library of Science, vol. 13(7), pages 1-14, July.
    3. David Brain & Laith Yakob & Adrian Barnett & Thomas Riley & Archie Clements & Kate Halton & Nicholas Graves, 2018. "Economic evaluation of interventions designed to reduce Clostridium difficile infection," PLOS ONE, Public Library of Science, vol. 13(1), pages 1-15, January.
    4. Lianna Hede Hammeken & Simon Mark Dahl Baunwall & Christian Lodberg Hvas & Lars Holger Ehlers, 2021. "Health economic evaluations comparing faecal microbiota transplantation with antibiotics for treatment of recurrent Clostridioides difficile infection: a systematic review," Health Economics Review, Springer, vol. 11(1), pages 1-8, December.

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