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Economic evaluation of fecal microbiota transplantation for the treatment of recurrent Clostridium difficile infection in Australia
Author(s) -
Merlo Gregory,
Graves Nicholas,
Brain David,
Connelly Luke B
Publication year - 2016
Publication title -
journal of gastroenterology and hepatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.214
H-Index - 130
eISSN - 1440-1746
pISSN - 0815-9319
DOI - 10.1111/jgh.13402
Subject(s) - clostridium difficile , medicine , vancomycin , fecal bacteriotherapy , randomized controlled trial , transplantation , quality of life (healthcare) , cost effectiveness , antibiotics , intensive care medicine , surgery , microbiology and biotechnology , risk analysis (engineering) , genetics , nursing , bacteria , biology , staphylococcus aureus
Background and Aim Clostridium difficile is the most common cause of hospital‐acquired diarrhea in Australia. In 2013, a randomized controlled trial demonstrated the effectiveness of fecal microbiota transplantation (FMT) for the treatment of recurrent Clostridium difficile infection (CDI). The aim of this study is to evaluate the cost‐effectiveness of fecal microbiota transplantation—via either nasoduodenal or colorectal delivery—compared with vancomycin for the treatment of recurrent CDI in Australia. Methods A Markov model was developed to compare the cost‐effectiveness of fecal microbiota transplantation compared with standard antibiotic therapy. A literature review of clinical evidence informed the structure of the model and the choice of parameter values. Clinical effectiveness was measured in terms of quality‐adjusted life years. Uncertainty in the model was explored using probabilistic sensitivity analysis. Results Both nasoduodenal and colorectal FMT resulted in improved quality of life and reduced cost compared with vancomycin. The incremental effectiveness of either FMT delivery compared with vancomycin was 1.2 (95% CI: 0.1, 2.3) quality‐adjusted life years, or 1.4 (95% CI: 0.4, 2.4) life years saved. Treatment with vancomycin resulted in an increased cost of AU$4094 (95% CI: AU$26, AU$8161) compared with nasoduodenal delivery of FMT and AU$4045 (95% CI: −AU$33, AU$8124) compared with colorectal delivery. The mean difference in cost between colorectal and nasoduodenal FMT was not significant. Conclusions If FMT, rather than vancomycin, became standard care for recurrent CDI in Australia, the estimated national healthcare savings would be over AU$4000 per treated person, with a substantial increase in quality of life.