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Cost‐effectiveness analysis of fecal microbiota transplantation for recurrent Clostridium difficile infection in patients with inflammatory bowel disease
Author(s) -
You Joyce H S,
Jiang Xinchan,
Lee Wally H,
Chan Paul K S,
Ng Siew C
Publication year - 2020
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.15002
Subject(s) - fidaxomicin , clostridium difficile , medicine , vancomycin , inflammatory bowel disease , confidence interval , gastroenterology , transplantation , disease , microbiology and biotechnology , antibiotics , genetics , staphylococcus aureus , biology , bacteria
Abstract Background and Aim Inflammatory bowel disease (IBD) patients are at risk for recurrent Clostridium difficile infection (RCDI). We aimed to evaluate the potential health economic and clinical outcomes of four strategies for management of RCDI in IBD patients from the perspective of public health‐care provider in Hong Kong. Methods A decision‐analytic model was designed to simulate outcomes of adult IBD patients with first RCDI treated with vancomycin, vancomycin plus bezlotoxumab, fidaxomicin and fecal microbiota transplantation (FMT). Model inputs were derived from literature and public data. Primary model outcomes were C. difficile infection (CDI)‐related direct medical cost and quality‐adjusted life‐years (QALYs) loss. Base‐case and sensitivity analysis were performed. Results Comparing to vancomycin, fidaxomicin and vancomycin plus bezlotoxumab, FMT saved 0.00318, 0.00149 and 0.00306 QALYs and reduced cost by USD3180, USD3790 and USD5514, respectively, in base‐case analysis. In probabilistic sensitivity analysis, FMT was cost‐saving when comparing to vancomycin, fidaxomicin and vancomycin plus bezlotoxumab by USD3765 (95% confidence interval [CI] 3732–3798; P < 0.001), USD3854 (95%CI 3827–3883; P < 0.001) and USD6501 (95%CI 6465–6,536; P < 0.001), respectively. The QALYs saved by FMT ( vs vancomycin) were 0.00386 QALYs (95%CI 0.00384–0.00388; P < 0.001), ( vs fidaxomicin) 0.00179 QALYs (95%CI 0.00177–0.00180; P < 0.001) and ( vs vancomycin plus bezlotoxumab) 0.00376 QALYs (95%CI 0.00374–0.00378; P < 0.001). FMT was found to save QALYs at lower cost in 99.3% ( vs vancomycin), 99.7% ( vs fidaxomicin) and 100.0% ( vs vancomycin plus bezlotoxumab) of the 10 000 Monte Carlo simulations. Conclusions FMT for IBD patients with RCDI appeared to save both direct medical cost and QALYs when comparing to vancomycin (with or without bezlotoxumab) and fidaxomicin.