The Most Optimal, Cost-Effective C diff Treatments Are Identified
After evaluating the Infectious Diseases Society of America (IDSA) 2018 guidelines for the diagnosis and treatment of patients with Clostridioides difficile infection (CDI), a group of researchers have determined the most cost-effective treatment regimens.
According to the study authors, the most optimal, cost-effective treatment regimens are fidaxomicin for nonsevere CDI, vancomycin for severe CDI, fidaxomicin for first recurrence, and fecal microbiota transplantation (FMT) for subsequent recurrence.
Because it is not as beneficial as other strategies, metronidazole was deemed a suboptimal treatment for patients with nonsevere CDI.
“The most effective treatments, with highest cure rates, are also cost-effective due to averted mortality, utility loss, and costs of rehospitalization and/or further treatments for recurrent CDI,” the researchers wrote.
To estimate the costs, effectiveness, and cost-effectiveness of the treatment regimens recommended in the IDSA guidelines, the researchers used a Markov model to simulate a cohort of patients presenting with an initial CDI diagnosis.
The model included stratification by the severity of the initial infection, as well as by the subsequent likelihood of cure, recurrence, mortality, and outcomes of subsequent recurrences.
The IDSA guidelines, in addition to published literature on treatment outcomes, were the sources of data for the analysis.
The optimal, cost-effective CDI treatment strategies that the researchers determined cost an additional $478 for 0.009 quality-adjusted life-years (QALY) gained per CDI patient; this resulted in an incremental cost-effectiveness ratio of $31,751 per QALY, below the willingness-to-pay threshold of $100,000 per QALY.
—Colleen Murphy
Reference:
Rajasingham R, Enns EA, Khoruts A, Vaughn BP. Cost-effectiveness of treatment regimens for Clostridioides difficile infection: an evaluation of the 2018 Infectious Diseases Society of America Guidelines. Clin Infect Dis. 2020;70(5)754-762. https://doi.org/10.1093/cid/ciz318.