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Cost-effectiveness of three different strategies for the treatment of first recurrent Clostridium difficile infection diagnosed in a community setting

Published online by Cambridge University Press:  02 July 2018

Simon W. Lam ,
Elizabeth A. Neuner ,
Thomas G. Fraser ,
David Delgado  and
Donald B. Chalfin
Simon W. Lam*
Affiliation:
Department of Pharmacy, Cleveland Clinic, Cleveland, Ohio
Elizabeth A. Neuner
Affiliation:
Department of Pharmacy, Cleveland Clinic, Cleveland, Ohio
Thomas G. Fraser
Affiliation:
Department of Infectious Diseases, Cleveland Clinic, Cleveland, Ohio
David Delgado
Affiliation:
Thomas Jefferson University, Philadelphia, Pennsylvania
Donald B. Chalfin
Affiliation:
Thomas Jefferson University, Philadelphia, Pennsylvania
*
Author for correspondence: Simon W. Lam, Cleveland Clinic, Department of Pharmacy, 9500 Euclid Avenue, JJN-01, Cleveland, OH 44195. E-mail: lams@ccf.org
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Abstract

Objective

A significant portion of patients with Clostridium difficile infections (CDI) experience recurrence, and there is little consensus on its treatment. With the availability of newer agents for CDI and the added burdens of recurrent disease, a cost-effectiveness analysis may provide insight on the most efficient use of resources.

Design

A decision-tree analysis was created to compare the cost-effectiveness of 3 possible treatments for patients with first CDI recurrence: oral vancomycin, fidaxomicin, or bezlotoxumab plus vancomycin. The model was performed from a payer’s perspective with direct cost inputs and a timeline of 1 year. A systematic review of literature was performed to identify clinical, utility, and cost data. Quality-adjusted life years (QALY) and incremental cost-effectiveness ratios were calculated. The willingness-to-pay (WTP) threshold was set at $100,000 per QALY gained. The robustness of the model was tested using one-way sensitivity analyses and probabilistic sensitivity analysis.

Results

Vancomycin had the lowest cost ($15,692) and was associated with a QALY gain of 0.8019 years. Bezlotoxumab plus vancomycin was a dominated strategy. Fidaxomicin led to a higher QALY compared to vancomycin, at an incremental cost of $500,975 per QALY gained. Based on our WTP threshold, vancomycin alone was the most cost-effective regimen for treating the first recurrence of CDI. Sensitivity analyses demonstrated the model’s robustness.

Conclusions

Vancomycin alone appears to be the most cost-effective regimen for the treatment of first recurrence of CDI. Fidaxomicin alone led to the highest QALY gained, but at a cost beyond what is considered cost-effective.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 39 , Issue 8 , August 2018 , pp. 924 - 930
Copyright
© 2018 by The Society for Healthcare Epidemiology of America. All rights reserved. 

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