title: Cost-effectiveness analysis of fecal microbiota transplantation for recurrent Clostridium difficile infection.
abstract: OBJECTIVE
  Clostridium difficile infection (CDI) places a high burden on the US healthcare system. Recurrent CDI (RCDI) occurs frequently. Recently proposed guidelines from the American College of Gastroenterology (ACG) and the American Gastroenterology Association (AGA) include fecal microbiota transplantation (FMT) as a therapeutic option for RCDI. The purpose of this study was to estimate the cost-effectiveness of FMT compared with vancomycin for the treatment of RCDI in adults, specifically following guidelines proposed by the ACG and AGA.
  
  
  METHODS
  We constructed a decision-analytic computer simulation using inputs from the published literature to compare the standard approach using tapered vancomycin to FMT for RCDI from the third-party payer perspective. Our effectiveness measure was quality-adjusted life years (QALYs). Because simulated patients were followed for 90 days, discounting was not necessary. One-way and probabilistic sensitivity analyses were performed.
  
  
  RESULTS
  Base-case analysis showed that FMT was less costly ($1,669 vs $3,788) and more effective (0.242 QALYs vs 0.235 QALYs) than vancomycin for RCDI. One-way sensitivity analyses showed that FMT was the dominant strategy (both less expensive and more effective) if cure rates for FMT and vancomycin were ≥70% and <91%, respectively, and if the cost of FMT was <$3,206. Probabilistic sensitivity analysis, varying all parameters simultaneously, showed that FMT was the dominant strategy over 10, 000 second-order Monte Carlo simulations.
  
  
  CONCLUSIONS
  Our results suggest that FMT may be a cost-saving intervention in managing RCDI. Implementation of FMT for RCDI may help decrease the economic burden to the healthcare system.
authors.affiliation: 1Department of Pediatrics,University of Utah,Salt Lake City,Utah.
authors.forename: Raghu U
authors.initials: RU
authors.lastname: Varier
authors.affiliation: 2Department of Pharmacotherapy,University of Utah,Salt Lake City,Utah.
authors.forename: Eman
authors.initials: E
authors.lastname: Biltaji
authors.affiliation: 3Department of Medicine,University of Pittsburgh School of Medicine,Pittsburgh,Pennsylvania.
authors.forename: Kenneth J
authors.initials: KJ
authors.lastname: Smith
authors.affiliation: 4Department of Health Policy and Management,University of Pittsburgh Graduate School of Public Health,Pittsburgh,Pennsylvania.
authors.forename: Mark S
authors.initials: MS
authors.lastname: Roberts
authors.affiliation: 1Department of Pediatrics,University of Utah,Salt Lake City,Utah.
authors.forename: M
authors.initials: M
authors.lastname: Kyle Jensen
authors.affiliation: 2Department of Pharmacotherapy,University of Utah,Salt Lake City,Utah.
authors.forename: Joanne
authors.initials: J
authors.lastname: LaFleur
authors.affiliation: 5Department of Internal Medicine,University of Utah,Salt Lake City,Utah.
authors.forename: Richard E
authors.initials: RE
authors.lastname: Nelson
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000191:economics / Q000627:therapeutic use; D016360:Clostridioides difficile; D017046:Cost Savings; D003362:Cost-Benefit Analysis; D016527:Drug Costs; D004761:Enterocolitis, Pseudomembranous / Q000188:drug therapy / Q000191:economics / Q000628:therapy*; D000069467:Fecal Microbiota Transplantation / Q000191:economics*; D017048:Health Care Costs; D006801:Humans; D019057:Quality-Adjusted Life Years; D014640:Vancomycin / Q000191:economics / Q000627:therapeutic use
chemical_list: D000900:Anti-Bacterial Agents; D014640:Vancomycin