title: Is fidaxomicin worth the cost? An economic analysis.
abstract: BACKGROUND
  In May 2011, the Food and Drug Administration approved fidaxomicin for the treatment of Clostridium difficile infection (CDI). It has been found to be noninferior to vancomycin; however, its cost-effectiveness for the treatment of CDI remains undetermined.
  
  
  METHODS
  We developed a decision analytic simulation model to determine the economic value of fidaxomicin for CDI treatment from the third-party payer perspective. We looked at CDI treatment in these 3 cases: (1) no fidaxomicin, (2) only fidaxomicin, and (3) fidaxomicin based on strain typing results.
  
  
  RESULTS
  The incremental cost-effectiveness ratio for fidaxomicin based on screening given current conditions was >$43.7 million per quality-adjusted life-year and using only fidaxomicin was dominated (ie, more costly and less effective) by the other 2 treatment strategies explored. The fidaxomicin strategy tended to remain dominated, even at lower costs. With approximately 50% of CDI due to the NAP1/BI/027 strain, a course of fidaxomicin would need to cost ≤$150 to be cost-effective in the treatment of all CDI cases and between $160 and $400 to be cost-effective for those with a non-NAP1/BI/027 strain (ie, treatment based on strain typing).
  
  
  CONCLUSIONS
  Given the current cost and NAP1/BI/027 accounting for approximately 50% of isolates, using fidaxomicin as a first-line treatment for CDI is not cost-effective. However, typing and treatment with fidaxomicin based on strain may be more promising depending on the costs of fidaxomicin.
authors.affiliation: Public Health Computational and Operations Research, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA. smm168@pitt.edu
authors.forename: Sarah M
authors.initials: SM
authors.lastname: Bartsch
authors.forename: Craig A
authors.initials: CA
authors.lastname: Umscheid
authors.forename: Neil
authors.initials: N
authors.lastname: Fishman
authors.forename: Bruce Y
authors.initials: BY
authors.lastname: Lee
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000617:Aminoglycosides / Q000191:economics* / Q000627:therapeutic use*; D000900:Anti-Bacterial Agents / Q000191:economics* / Q000627:therapeutic use*; D016360:Clostridioides difficile / Q000302:isolation & purification*; D003015:Clostridium Infections / Q000188:drug therapy* / Q000382:microbiology; D003362:Cost-Benefit Analysis; D005260:Female; D000077732:Fidaxomicin; D017048:Health Care Costs; D006801:Humans; D008297:Male; D008875:Middle Aged; D055815:Young Adult
chemical_list: D000617:Aminoglycosides; D000900:Anti-Bacterial Agents; D000077732:Fidaxomicin
keywords: Clostridium difficile; cost; economics; fidaxomicin; treatment