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Cost-Effectiveness of Competing Treatment Strategies for Clostridium difficile Infection: A Systematic Review

Published online by Cambridge University Press:  21 February 2018

Phuc Le ,
Van T. Nghiem ,
Patricia Dolan Mullen  and
Abhishek Deshpande
Phuc Le
Affiliation:
Center for Value-Based Care Research, Medicine Institute, Cleveland Clinic, Cleveland, Ohio
Van T. Nghiem
Affiliation:
Department of Management, Policy and Community Health, The University of Texas School of Public Health, Houston, Texas
Patricia Dolan Mullen
Affiliation:
Department of Health Promotion and Behavioral Sciences, Center for Health Promotion and Prevention Research, The University of Texas School of Public Health, Houston, Texas
Abhishek Deshpande*
Affiliation:
Center for Value-Based Care Research, Medicine Institute, Cleveland Clinic, Cleveland, Ohio Department of Infectious Disease, Medicine Institute, Cleveland Clinic, Cleveland, Ohio
*
Address correspondence to Abhishek Deshpande MD, PhD, Center for Value-based Care Research, Medicine Institute, Cleveland Clinic, 9500 Euclid Ave, G10, Cleveland, OH 44195 (deshpaa2@ccf.org).
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Abstract

BACKGROUND

Clostridium difficile infection (CDI) presents a substantial economic burden and is associated with significant morbidity. While multiple treatment strategies have been evaluated, a cost-effective management strategy remains unclear.

OBJECTIVE

We conducted a systematic review to assess cost-effectiveness analyses of CDI treatment and to summarize key issues for clinicians and policy makers to consider.

METHODS

We searched PubMed and 5 other databases from inception to August 2016. These searches were not limited by study design or language of publication. Two reviewers independently screened the literature, abstracted data, and assessed methodological quality using the Drummond and Jefferson checklist. We extracted data on study characteristics, type of CDI, treatment characteristics, and model structure and inputs.

RESULTS

We included 14 studies, and 13 of these were from high-income countries. More than 90% of these studies were deemed moderate-to-high or high quality. Overall, 6 studies used a decision-tree model and 7 studies used a Markov model. Cost of therapy, time horizon, treatment cure rates, and recurrence rates were common influential factors in the study results. For initial CDI, fidaxomicin was a more cost-effective therapy than metronidazole or vancomycin in 2 of 3 studies. For severe initial CDI, 2 of 3 studies found fidaxomicin to be the most cost-effective therapy. For recurrent CDI, fidaxomicin was cost-effective in 3 of 5 studies, while fecal microbiota transplantation (FMT) by colonoscopy was consistently cost-effective in 4 of 4 studies.

CONCLUSIONS

The cost-effectiveness of fidaxomicin compared with other pharmacologic therapies was not definitive for either initial or recurrent CDI. Despite its high cost, FMT by colonoscopy may be a cost-effective therapy for recurrent CDI. A consensus on model design and assumptions are necessary for future comparison of CDI treatment.

Infect Control Hosp Epidemiol 2018;39:412–424

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 39 , Issue 4 , April 2018 , pp. 412 - 424
Copyright
© 2018 by The Society for Healthcare Epidemiology of America. All rights reserved 

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