title: Cost-effectiveness analysis of fidaxomicin versus vancomycin in Clostridium difficile infection.
abstract: OBJECTIVE
  Fidaxomicin was non-inferior to vancomycin with respect to clinical cure rates in the treatment of Clostridium difficile infections (CDIs) in two Phase III trials, but was associated with significantly fewer recurrences than vancomycin. This economic analysis investigated the cost-effectiveness of fidaxomicin compared with vancomycin in patients with severe CDI and in patients with their first CDI recurrence.
  
  
  METHODS
  A 1 year time horizon Markov model with seven health states was developed from the perspective of Scottish public healthcare providers. Model inputs for effectiveness, resource use, direct costs and utilities were obtained from published sources and a Scottish expert panel. The main model outcome was the incremental cost-effectiveness ratio (ICER), expressed as cost per quality-adjusted life year (QALY), for fidaxomicin versus vancomycin; ICERs were interpreted using willingness-to-pay thresholds of £20,000/QALY and £30,000/QALY. One-way and probabilistic sensitivity analyses were performed.
  
  
  RESULTS
  Total costs were similar with fidaxomicin and vancomycin in patients with severe CDI (£14,515 and £14,344, respectively) and in patients with a first recurrence (£16,535 and £16,926, respectively). Improvements in clinical outcomes with fidaxomicin resulted in small QALY gains versus vancomycin (severe CDI, +0.010; patients with first recurrence, +0.019). Fidaxomicin was cost-effective in severe CDI (ICER £16,529/QALY) and dominant (i.e. more effective and less costly) in patients with a first recurrence. The probability that fidaxomicin was cost-effective at a willingness-to-pay threshold of £30,000/QALY was 60% for severe CDI and 68% in a first recurrence.
  
  
  CONCLUSIONS
  Fidaxomicin is cost-effective in patients with severe CDI and in patients with a first CDI recurrence versus vancomycin.
authors.affiliation: Ninewells Hospital & Medical School, Dundee DD1 9SY, UK.
authors.forename: Dilip
authors.initials: D
authors.lastname: Nathwani
authors.affiliation: Department of Internal Medicine, Clinical Trials Centre Cologne, ZKS Köln, BMBF 01KN1106, Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), University of Cologne, 50924 Cologne, Germany.
authors.forename: Oliver A
authors.initials: OA
authors.lastname: Cornely
authors.affiliation: Quintiles Consulting, Siriusdreef 10, 2132 WT Hoofddorp, The Netherlands.
authors.forename: Anke K
authors.initials: AK
authors.lastname: Van Engen
authors.affiliation: Astellas Pharma Europe Ltd, 2000 Hillswood Drive, Chertsey, Surrey KT16 0RS, UK.
authors.forename: Olatunji
authors.initials: O
authors.lastname: Odufowora-Sita
authors.affiliation: Astellas Pharma Europe Ltd, 2000 Hillswood Drive, Chertsey, Surrey KT16 0RS, UK.
authors.forename: Peny
authors.initials: P
authors.lastname: Retsa
authors.affiliation: Astellas Pharma Europe Ltd, 2000 Hillswood Drive, Chertsey, Surrey KT16 0RS, UK isaac.odeyemi@astellas.com.
authors.forename: Isaac A O
authors.initials: IA
authors.lastname: Odeyemi
mesh_terms: D000617:Aminoglycosides / Q000191:economics* / Q000494:pharmacology / Q000627:therapeutic use; D000900:Anti-Bacterial Agents / Q000191:economics* / Q000494:pharmacology / Q000627:therapeutic use; D016360:Clostridioides difficile / Q000187:drug effects; D003015:Clostridium Infections / Q000188:drug therapy / Q000191:economics*; D003362:Cost-Benefit Analysis / Q000379:methods*; D000077732:Fidaxomicin; D006801:Humans; D008390:Markov Chains; D014640:Vancomycin / Q000191:economics* / Q000494:pharmacology / Q000627:therapeutic use
chemical_list: D000617:Aminoglycosides; D000900:Anti-Bacterial Agents; D014640:Vancomycin; D000077732:Fidaxomicin
keywords: antibacterials; economic; model
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