FMT a cost-effective treatment for recurrent C. difficile
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Fecal microbiota transplantation appears to be a cost-effective treatment for recurrent Clostridioides difficile infection, or CDI, but not for the initial incidence of CDI, according to findings from a systematic review published in Infection Control & Hospital Epidemiology.
“The major problem with CDI is that, despite adequate antibiotic therapy, 10% to 30% of patients will experience a recurrence, with the risk approaching 60% after the third episode,” Virginie Nerich, PharmD, PhD, from the department of pharmacy at University Hospital of Besançon, and colleagues wrote. “Fecal microbiota transplantation (FMT) is an effective therapy for CDI, leading to a significant reduction of recurrent [Clostridioides] difficile infection (rCDI) and reduced incidence of adverse events when compared to conventional antibiotics.”
Nerich and colleagues noted that FMT is recommended in Europe and the United States for multiple rCDI but has not been recommended for other conditions such as ulcerative colitis and Crohn’s disease. Last year, the FDA issued a safety alert regarding FMT after two patients from two separate clinical trials developed invasive drug-resistant infections, and one died. Experts said the cases showed that the screening process for FMT donors is still evolving.
Nerich and colleagues searched PubMed and Cochrane for economic evaluation (EE) studies of FMT published before July 1, 2019. They included nine economic evaluations in their review, including eight cost-utility analyses. All studies were deemed to be of high quality.
Each of the cost-utility analyses related to rCDI and inflammatory bowel disease showed that FMT was cost-effective compared with other treatments investigated at a threshold of $50,000 or less per quality-adjusted life year.
“FMT was also cost-effective because it was dominant in four EEs compared with vancomycin and was dominant in two EEs compared with fidaxomicin,” Nerich and colleagues wrote.
One economic evaluation about initial CDI showed that FMT was dominated by metronidazole — which is no longer recommended as a first-line therapy in this indication — but was dominant vs. vancomycin, they reported.
“FMT seems to be a promising and cost-effective treatment for rCDI but not for initial CDI,” the authors concluded. “American and European guidelines recommend the use of FMT for the treatment of rCDI, but additional economic evaluations are needed to accurately identify its place within the therapeutic armamentarium of this disease.” – by Caitlyn Stulpin
Disclosures: The authors report no relevant financial disclosures.
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