Fecal Transplants by Colonoscopy and Capsules Are Cost-Effective Strategies for Treating Recurrent Clostridioides difficile Infection

Abstract

Background

Recurrent Clostridioides difficile infections (CDIs) occur frequently and pose a substantial economic burden on the US healthcare system. The landscape for the treatment of CDI is evolving.

Aim

To elucidate the most cost-effective strategy for managing recurrent CDI.

Methods

A decision tree analysis was created from a modified third-party payer’s perspective to compare the cost-effectiveness of five strategies for patients experiencing their first CDI recurrence: oral vancomycin, fidaxomicin, fecal microbiota transplant (FMT) via colonoscopy, FMT via oral capsules, and a one-time infusion of bezlotoxumab with vancomycin. Effectiveness measures were quality-adjusted life years (QALY). A willingness-to-pay (WTP) threshold of $100,000 per QALY was set. One-way and probabilistic sensitivity analyses were performed.

Results

Base-case analysis showed that FMT via colonoscopy was associated with the lowest cost at $5250 and that FMT via capsules was also a cost-effective strategy with an incremental cost–effectiveness ratio (ICER) of $31205/QALY. Sensitivity analyses demonstrated that FMT delivered by oral capsules and colonoscopy was comparable cost-effective modalities. At its current cost and effectiveness, bezlotoxumab was not a cost-effective strategy.

Conclusions

FMT via oral capsules and colonoscopy is both cost-effective strategies to treat the first recurrence of CDI. Further real-world economic studies are needed to understand the cost-effectiveness of all available strategies.

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AMG serves as the guarantor of the article. All authors contributed to the inception, design, and research of the study. All authors approved the final version of the manuscript.

Corresponding author

Correspondence to Yuying Luo.

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Ari M. Grinspan has received lecture fees and honorarium from Merck.

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Luo, Y., Lucas, A.L. & Grinspan, A.M. Fecal Transplants by Colonoscopy and Capsules Are Cost-Effective Strategies for Treating Recurrent Clostridioides difficile Infection. Dig Dis Sci 65, 1125–1133 (2020). https://doi.org/10.1007/s10620-019-05821-1

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Keywords

  • Cost-effectiveness
  • Recurrent Clostridioides difficile infections
  • Fecal microbiota transplants
  • Bezlotoxumab