title: Cost-Effectiveness Analysis of Six Strategies to Treat Recurrent Clostridium difficile Infection.
abstract: OBJECTIVE
  To assess the cost-effectiveness of six treatment strategies for patients diagnosed with recurrent Clostridium difficile infection (CDI) in Canada: 1. oral metronidazole; 2. oral vancomycin; 3.oral fidaxomicin; 4. fecal transplantation by enema; 5. fecal transplantation by nasogastric tube; and 6. fecal transplantation by colonoscopy.
  
  
  CONCLUSIONS
  Public insurer for all hospital and physician services.
  
  
  METHODS
  Ontario, Canada.
  
  
  METHODS
  A decision analytic model was used to model costs and lifetime health effects of each strategy for a typical patient experiencing up to three recurrences, over 18 weeks. Recurrence data and utilities were obtained from published sources. Cost data was obtained from published sources and hospitals in Toronto, Canada. The willingness-to-pay threshold was $50,000/QALY gained.
  
  
  RESULTS
  Fecal transplantation by colonoscopy dominated all other strategies in the base case, as it was less costly and more effective than all alternatives. After accounting for uncertainty in all model parameters, there was an 87% probability that fecal transplantation by colonoscopy was the most beneficial strategy. If colonoscopy was not available, fecal transplantation by enema was cost-effective at $1,708 per QALY gained, compared to metronidazole. In addition, fecal transplantation by enema was the preferred strategy if the probability of recurrence following this strategy was below 8.7%. If fecal transplantation by any means was unavailable, fidaxomicin was cost-effective at an additional cost of $25,968 per QALY gained, compared to metronidazole.
  
  
  CONCLUSIONS
  Fecal transplantation by colonoscopy (or enema, if colonoscopy is unavailable) is cost-effective for treating recurrent CDI in Canada. Where fecal transplantation is not available, fidaxomicin is also cost-effective.
authors.affiliation: Department of Medicine, University of Toronto, Toronto, Canada.|Department of Medicine, University Health Network, Toronto, Canada.
authors.forename: Lauren
authors.initials: L
authors.lastname: Lapointe-Shaw
authors.affiliation: Department of Medicine, University Health Network, Toronto, Canada.
authors.forename: Kim L
authors.initials: KL
authors.lastname: Tran
authors.affiliation: Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada.
authors.forename: Peter C
authors.initials: PC
authors.lastname: Coyte
authors.affiliation: Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada.
authors.forename: Rebecca L
authors.initials: RL
authors.lastname: Hancock-Howard
authors.affiliation: Department of Medicine, University of Toronto, Toronto, Canada.|Department of Medicine, Toronto East General Hospital, Toronto, Canada.
authors.forename: Jeff
authors.initials: J
authors.lastname: Powis
authors.affiliation: Department of Medicine, University of Toronto, Toronto, Canada.|Department of Medicine, University Health Network, Toronto, Canada.|Department of Medicine and Medical Microbiology, Mount Sinai Hospital, Toronto, Canada.
authors.forename: Susan M
authors.initials: SM
authors.lastname: Poutanen
authors.affiliation: Department of Medicine, University of Toronto, Toronto, Canada.|Department of Medicine, University Health Network, Toronto, Canada.
authors.forename: Susy
authors.initials: S
authors.lastname: Hota
mesh_terms: D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000191:economics*; D002170:Canada; D016360:Clostridioides difficile; D003365:Costs and Cost Analysis; D004761:Enterocolitis, Pseudomembranous / Q000191:economics* / Q000628:therapy; D000069467:Fecal Microbiota Transplantation / Q000191:economics*; D005260:Female; D006801:Humans; D008297:Male
chemical_list: D000900:Anti-Bacterial Agents