Cost-effectiveness of treatment regimens for clostridioides difficile infection: An evaluation of the 2018 infectious diseases Society of America guidelines

Research output: Contribution to journalArticlepeer-review

11 Scopus citations

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.

Original languageEnglish (US)
Pages (from-to)754-762
Number of pages9
JournalClinical Infectious Diseases
Volume70
Issue number5
DOIs
StatePublished - Mar 1 2020

Bibliographical note

Funding Information:
Potential conflicts of interest. E. A. E. has received grants from the NIH, and personal fees from ViiV Healthcare. B. P. V. has received personal fees from AbbVie and Janssen, and grants from Takeda, Roche, Celgene, and Diasorin. All other authors report no potential conflicts of interest. All authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Conflicts that the editors consider relevant to the content of the manuscript have been disclosed.

Funding Information:
Financial support. This work was supported by the National Institutes of Health (NIH) (grant numbers K23AI13885 to R. R. and K25AI118476 to E. A. E.).

Publisher Copyright:
© The Author(s) 2019.

Keywords

  • Clostridioides difficile infection
  • Clostridium difficile infection
  • Cost-effectiveness

PubMed: MeSH publication types

  • Journal Article
  • Research Support, N.I.H., Extramural

Fingerprint

Dive into the research topics of 'Cost-effectiveness of treatment regimens for clostridioides difficile infection: An evaluation of the 2018 infectious diseases Society of America guidelines'. Together they form a unique fingerprint.

Cite this