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Cost-Effectiveness Analysis of Five Competing Strategies for the Management of Multiple Recurrent Community-Onset Clostridium difficile Infection in France

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  • Emilie Baro
  • Tatiana Galperine
  • Fanette Denies
  • Damien Lannoy
  • Xavier Lenne
  • Pascal Odou
  • Benoit Guery
  • Benoit Dervaux

Abstract

Background: Clostridium difficile infection (CDI) is characterized by high rates of recurrence, resulting in substantial health care costs. The aim of this study was to analyze the cost-effectiveness of treatments for the management of second recurrence of community-onset CDI in France. Methods: We developed a decision-analytic simulation model to compare 5 treatments for the management of second recurrence of community-onset CDI: pulsed-tapered vancomycin, fidaxomicin, fecal microbiota transplantation (FMT) via colonoscopy, FMT via duodenal infusion, and FMT via enema. The model outcome was the incremental cost-effectiveness ratio (ICER), expressed as cost per quality-adjusted life year (QALY) among the 5 treatments. ICERs were interpreted using a willingness-to-pay threshold of €32,000/QALY. Uncertainty was evaluated through deterministic and probabilistic sensitivity analyses. Results: Three strategies were on the efficiency frontier: pulsed-tapered vancomycin, FMT via enema, and FMT via colonoscopy, in order of increasing effectiveness. FMT via duodenal infusion and fidaxomicin were dominated (i.e. less effective and costlier) by FMT via colonoscopy and FMT via enema. FMT via enema compared with pulsed-tapered vancomycin had an ICER of €18,092/QALY. The ICER for FMT via colonoscopy versus FMT via enema was €73,653/QALY. Probabilistic sensitivity analysis with 10,000 Monte Carlo simulations showed that FMT via enema was the most cost-effective strategy in 58% of simulations and FMT via colonoscopy was favored in 19% at a willingness-to-pay threshold of €32,000/QALY. Conclusions: FMT via enema is the most cost-effective initial strategy for the management of second recurrence of community-onset CDI at a willingness-to-pay threshold of €32,000/QALY.

Suggested Citation

  • 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.
    • Handle: RePEc:plo:pone00:0170258
    DOI: 10.1371/journal.pone.0170258
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    References listed on IDEAS

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    1. Don Husereau & Michael Drummond & Stavros Petrou & Chris Carswell & David Moher & Dan Greenberg & Federico Augustovski & Andrew Briggs & Josephine Mauskopf & Elizabeth Loder, 2013. "Consolidated Health Economic Evaluation Reporting Standards (CHEERS) statement," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 14(3), pages 367-372, June.
    2. 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.
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    1. 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.

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