Economic evaluation of fecal microbiota transplantation for the treatment of recurrent Clostridium difficile infection in Australia

Merlo, Gregory, Graves, Nicholas, Brain, David and Connelly, Luke B. (2016) Economic evaluation of fecal microbiota transplantation for the treatment of recurrent Clostridium difficile infection in Australia. Journal of Gastroenterology and Hepatology, 31 12: 1927-1932. doi:10.1111/jgh.13402

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Author Merlo, Gregory
Graves, Nicholas
Brain, David
Connelly, Luke B.
Title Economic evaluation of fecal microbiota transplantation for the treatment of recurrent Clostridium difficile infection in Australia
Formatted title
Economic evaluation of fecal microbiota transplantation for the treatment of recurrent Clostridium difficile infection in Australia
Journal name Journal of Gastroenterology and Hepatology   Check publisher's open access policy
ISSN 1440-1746
0815-9319
Publication date 2016-12-01
Sub-type Article (original research)
DOI 10.1111/jgh.13402
Open Access Status File (Author Post-print)
Volume 31
Issue 12
Start page 1927
End page 1932
Total pages 6
Place of publication Richmond, VIC, Australia
Publisher Wiley-Blackwell Publishing Asia
Language eng
Formatted abstract
Background and Aim: Clostridium difficile is the most common cause of hospital-acquired diarrhea in Australia. In 2013, a randomized controlled trial demonstrated the effectiveness of fecal microbiota transplantation (FMT) for the treatment of recurrent Clostridium difficile infection (CDI). The aim of this study is to evaluate the cost-effectiveness of fecal microbiota transplantation—via either nasoduodenal or colorectal delivery—compared with vancomycin for the treatment of recurrent CDI in Australia.

Methods: A Markov model was developed to compare the cost-effectiveness of fecal microbiota transplantation compared with standard antibiotic therapy. A literature review of clinical evidence informed the structure of the model and the choice of parameter values. Clinical effectiveness was measured in terms of quality-adjusted life years. Uncertainty in the model was explored using probabilistic sensitivity analysis.

Results: Both nasoduodenal and colorectal FMT resulted in improved quality of life and reduced cost compared with vancomycin. The incremental effectiveness of either FMT delivery compared with vancomycin was 1.2 (95% CI: 0.1, 2.3) quality-adjusted life years, or 1.4 (95% CI: 0.4, 2.4) life years saved. Treatment with vancomycin resulted in an increased cost of AU$4094 (95% CI: AU$26, AU$8161) compared with nasoduodenal delivery of FMT and AU$4045 (95% CI: −AU$33, AU$8124) compared with colorectal delivery. The mean difference in cost between colorectal and nasoduodenal FMT was not significant.

Conclusions: If FMT, rather than vancomycin, became standard care for recurrent CDI in Australia, the estimated national healthcare savings would be over AU$4000 per treated person, with a substantial increase in quality of life.
Keyword Clostridium difficile infection
Cost-effectiveness
Economic evaluation
Fecal microbiota transplantation
Vancomycin
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: HERDC Pre-Audit
School of Health and Rehabilitation Sciences Publications
 
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