title: Economic evaluation of fecal microbiota transplantation for the treatment of recurrent Clostridium difficile infection in Australia.
abstract: OBJECTIVE
  Clostridium difficile is the most common cause of hospital-acquired diarrhea in Australia. In 2013, a randomized controlled trial demonstrated the effectiveness of fecal microbiota transplantation (FMT) for the treatment of recurrent Clostridium difficile infection (CDI). The aim of this study is to evaluate the cost-effectiveness of fecal microbiota transplantation-via either nasoduodenal or colorectal delivery-compared with vancomycin for the treatment of recurrent CDI in Australia.
  
  
  METHODS
  A Markov model was developed to compare the cost-effectiveness of fecal microbiota transplantation compared with standard antibiotic therapy. A literature review of clinical evidence informed the structure of the model and the choice of parameter values. Clinical effectiveness was measured in terms of quality-adjusted life years. Uncertainty in the model was explored using probabilistic sensitivity analysis.
  
  
  RESULTS
  Both nasoduodenal and colorectal FMT resulted in improved quality of life and reduced cost compared with vancomycin. The incremental effectiveness of either FMT delivery compared with vancomycin was 1.2 (95% CI: 0.1, 2.3) quality-adjusted life years, or 1.4 (95% CI: 0.4, 2.4) life years saved. Treatment with vancomycin resulted in an increased cost of AU$4094 (95% CI: AU$26, AU$8161) compared with nasoduodenal delivery of FMT and AU$4045 (95% CI: -AU$33, AU$8124) compared with colorectal delivery. The mean difference in cost between colorectal and nasoduodenal FMT was not significant.
  
  
  CONCLUSIONS
  If FMT, rather than vancomycin, became standard care for recurrent CDI in Australia, the estimated national healthcare savings would be over AU$4000 per treated person, with a substantial increase in quality of life.
authors.affiliation: Queensland University of Technology (QUT), Australian Centre for Health Services Innovation (AusHSI) and the Centre of Research Excellence in Reducing Healthcare Associated Infections, Brisbane, Queensland, Australia.
authors.forename: Gregory
authors.initials: G
authors.lastname: Merlo
authors.affiliation: Queensland University of Technology (QUT), Australian Centre for Health Services Innovation (AusHSI) and the Centre of Research Excellence in Reducing Healthcare Associated Infections, Brisbane, Queensland, Australia.
authors.forename: Nicholas
authors.initials: N
authors.lastname: Graves
authors.affiliation: Queensland University of Technology (QUT), Australian Centre for Health Services Innovation (AusHSI) and the Centre of Research Excellence in Reducing Healthcare Associated Infections, Brisbane, Queensland, Australia.
authors.forename: David
authors.initials: D
authors.lastname: Brain
authors.affiliation: The University of Queensland, Faculty of Health and Behavioural Sciences and Centre for the Business and Economics of Health, Brisbane, Queensland, Australia.
authors.forename: Luke B
authors.initials: LB
authors.lastname: Connelly
mesh_terms: D000900:Anti-Bacterial Agents / Q000191:economics / Q000627:therapeutic use; D001315:Australia; D016360:Clostridioides difficile / Q000472:pathogenicity*; D017046:Cost Savings; D003362:Cost-Benefit Analysis; D016527:Drug Costs; D004761:Enterocolitis, Pseudomembranous / Q000175:diagnosis / Q000191:economics* / Q000382:microbiology / Q000601:surgery*; D000069467:Fecal Microbiota Transplantation / Q000009:adverse effects / Q000191:economics*; D000069196:Gastrointestinal Microbiome; D017048:Health Care Costs; D006801:Humans; D007422:Intestines / Q000382:microbiology*; D008390:Markov Chains; D018803:Models, Economic; D011788:Quality of Life; D019057:Quality-Adjusted Life Years; D012008:Recurrence; D013997:Time Factors; D016896:Treatment Outcome; D014640:Vancomycin / Q000191:economics / Q000627:therapeutic use
chemical_list: D000900:Anti-Bacterial Agents; D014640:Vancomycin
keywords: Clostridium difficile infection; cost-effectiveness; economic evaluation; fecal microbiota transplantation; vancomycin