title: Cost-Effectiveness Analysis of the Use of Probiotics for the Prevention of Clostridium difficile-Associated Diarrhea in a Provincial Healthcare System.
abstract: OBJECTIVE To conduct a full economic evaluation assessing the costs and consequences related to probiotic use for the primary prevention of Clostridium difficile-associated diarrhea (CDAD). DESIGN Cost-effectiveness analysis using decision analytic modeling. METHODS A cost-effectiveness analysis was used to evaluate the risk of CDAD and the costs of receiving oral probiotics versus not over a time horizon of 30 days. The target population modeled was all adult inpatients receiving any therapeutic course of antibiotics from a publicly funded healthcare system perspective. Effectiveness estimates were based on a recent systematic review of probiotics for the primary prevention of CDAD. Additional estimates came from local data and the literature. Sensitivity analyses were conducted to assess how plausible changes in variables impacted the results. RESULTS Treatment with oral probiotics led to direct costs of CDN $24 per course of treatment per patient. On average, patients treated with oral probiotics had a lower overall cost compared with usual care (CDN $327 vs $845). The risk of CDAD was reduced from 5.5% in those not receiving oral probiotics to 2% in those receiving oral probiotics. These results were robust to plausible variation in all estimates. CONCLUSIONS Oral probiotics as a preventive strategy for CDAD resulted in a lower risk of CDAD as well as cost-savings. The cost-savings may be greater in other healthcare systems that experience a higher incidence and cost associated with CDAD. Infect Control Hosp Epidemiol 2016;37:1079-1086.
authors.affiliation: 1Infection Prevention and Control,Calgary and Area,Alberta Health Services (AHS),Calgary,Alberta,Canada.
authors.forename: Jenine R
authors.initials: JR
authors.lastname: Leal
authors.affiliation: 3Department of Medicine,University of Calgary and AHS,Calgary,Alberta,Canada.
authors.forename: Steven J
authors.initials: SJ
authors.lastname: Heitman
authors.affiliation: 3Department of Medicine,University of Calgary and AHS,Calgary,Alberta,Canada.
authors.forename: John M
authors.initials: JM
authors.lastname: Conly
authors.affiliation: 1Infection Prevention and Control,Calgary and Area,Alberta Health Services (AHS),Calgary,Alberta,Canada.
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Henderson
authors.affiliation: 2Department of Community Health Sciences,University of Calgary,Calgary,Alberta,Canada.
authors.forename: Braden J
authors.initials: BJ
authors.lastname: Manns
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002170:Canada; D016360:Clostridioides difficile; D017046:Cost Savings; D003362:Cost-Benefit Analysis; D003627:Data Interpretation, Statistical; D003967:Diarrhea / Q000382:microbiology / Q000517:prevention & control*; D004761:Enterocolitis, Pseudomembranous / Q000150:complications*; D005260:Female; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D019936:Probiotics / Q000191:economics* / Q000627:therapeutic use; D016032:Randomized Controlled Trials as Topic; D055815:Young Adult