Clin Microbiol Infect. 2021 Apr 17:S1198-743X(21)00187-7. doi: 10.1016/j.cmi.2021.04.004. Online ahead of print.
OBJECTIVES: Treatment of Clostridioides difficile infection (CDI) has undergone significant change in recent years with the introduction of fidaxomicin and bezlotoxumab. This study evaluated the cost-effectiveness of fidaxomicin and bezlotoxumab for initial CDI compared to standard therapy with oral vancomycin.
METHODS: A Markov model with 8 health states was built based on transition probabilities, costs, and health utilities derived from literature to evaluate the cost-effectiveness of standard fidaxomicin, bezlotoxumab plus vancomycin, and extended-pulsed fidaxomicin vs. standard oral vancomycin over a lifetime horizon from the United States societal perspective.
RESULTS: For overall CDI treatment, oral vancomycin had the lowest cost of $39,178 and was associated with a gain of 11.64 quality-adjusted life years (QALYs). Standard fidaxomicin had a relatively higher QALY gain of 11.94 than vancomycin at an incremental cost of $495 per QALY. Bezlotoxumab plus vancomycin led to a QALY gain of 11.77 at an incremental cost of $17,746 per QALY, and extended-pulsed fidaxomicin regimen had a QALY gain of 11.65 at an incremental cost of $205,841 per QALY. At the willingness-to-pay (WTP) threshold of $150,000 per QALY, bezlotoxumab plus vancomycin and fidaxomicin were always cost-effective compared to vancomycin alone, yielding incremental net monetary benefits (INMBs) of $17,011 and $44,308, respectively. One-way sensitivity analysis suggested that the probabilities of sustained cure from the initial episode were the most sensitive inputs, and results were overall not particularly sensitive to any drug costs.
CONCLUSIONS: Based on a WTP threshold of $150,000, fidaxomicin and bezlotoxumab plus vancomycin were estimated to be more cost-effective for treating an episode of CDI and preventing further recurrence than standard of care vancomycin. The addition of bezlotoxumab to vancomycin and extended-pulsed fidaxomicin were dominated by standard fidaxomicin.