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Clinical and economic benefits of fidaxomicin compared to vancomycin for Clostridium difficile infection.
Antimicrob Agents Chemother. 2015 Aug 31;
Authors: Gallagher JC, Reilly JP, Navalkele B, Downham G, Haynes K, Trivedi M
Abstract
OBJECTIVES: We studied the clinical and economic impact of a protocol encouraging fidaxomicin first-line for Clostridium difficile infection (CDI) in patients hospitalized during a two-year period.
MATERIALS AND METHODS: This study evaluated patients who received oral vancomycin or fidaxomicin for the treatment of CDI during a 2-year period. All included patients were eligible for fidaxomicin via a protocol that encouraged its use for select patients. The primary clinical endpoint was 90-day readmission with a diagnosis of CDI. Hospital charges and insurance reimbursements for readmissions were calculated along with the cost of CDI therapy to estimate the financial impact of the choice of therapy.
RESULTS: Recurrences were seen in 10/49 (20.4%) fidaxomicin patients and 19/46 (41.3%) vancomycin patients (p=0.027). In a multivariate analysis that included severity of CDI, serum creatinine increases, and concomitant antibiotic use, only fidaxomicin was significantly associated with decreased recurrence (aOR 0.33, 95% CI 0.12-0.93). The total length of stay of readmitted patients was 183 days for vancomycin and 87 days for fidaxomicin, with costs of $454,800 and $196,200 respectively. Readmissions for CDI were reimbursed based upon the severity of CDI, totaling $151,136 for vancomycin and $107,176 for fidaxomicin. Fidaxomicin drug costs totaled $62,112 and vancomycin drug costs were $6,646. We calculated that the hospital lost an average of $3,286 per fidaxomicin-treated patient and $6,333 per vancomycin-treated patient, thus saving $3,047 per patient with fidaxomicin.
CONCLUSIONS: Fidaxomicin use for CDI prevented readmission and decreased hospital costs compared to oral vancomycin.
PMID: 26324268 [PubMed - as supplied by publisher]