Cost-effectiveness of treatment regimens for Clostridioides difficile infection -an evaluation of the 2018 Infectious Diseases Society of America guidelines.
Clin Infect Dis. 2019 Apr 17;:
Authors: Rajasingham R, Enns EA, Khoruts A, Vaughn BP
BACKGROUND: In 2018, the Infectious Disease Society of America (IDSA) published guidelines for diagnosis and treatment of Clostridioides 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 non-severe initial CDI, vancomycin for severe CDI, fidaxomicin for first recurrence, and 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 non-severe CDI as it is less beneficial than alternative strategies. The preferred treatment regimen is fidaxomicin for non-severe 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 re-hospitalization and/or further treatments for recurrent CDI.
PMID: 31001619 [PubMed - as supplied by publisher]