Fidaxomicin, Vancomycin, or Metronidazole? Comparing C Difficile Treatment Cost-Efficacy

Though the drug is initially more expensive, treating C diff infection with fidaxomicin reduced costs overall by reducing CDI recurrences.

Though the drug is initially more expensive, treating C diff infection with fidaxomicin reduced costs overall by reducing CDI recurrences.

You can’t talk antibiotics without discussing Clostridioides difficile. The highly resistant bacterium can cause debilitating, recurring, and even fatal infection. Killing C diff requires strong antibiotics, but how cost-effective are these treatments?

A new study, published on MDPI, compared the real-world cost-effectiveness and budget impact of fidaxomicin, vancomycin, and metronidazole for C difficile infection (CDI).

The investigators were motivated to complete this study in response to previous reports that although fidaxomicin selectively kills C diff, it is initially more expensive than vancomycin and metronidazole.

Because fidaxomicin is a macrocyclic antibacterial drug that only targets C diff bacteria, it may significantly reduce the likelihood of CDI recurrence. This is vital, as 20-30% of CDI patients have a recurrence within 2 months of successful treatment, and each recurrence is more deadly.

CDI recurrences are commonly caused by the same antibiotics that are designed to cure the infection in the first place. These powerful agents wipe out the good gut bacteria along with the bad, often leaving the highly resilient C diff spores to germinate with no competition.

Thus, a targeted agent like fidaxomicin would be an ideal choice for CDI patients, if the investigators could prove that the higher initial cost of the drug compensated by reducing subsequent expensive recurrences.

The retrospective study utilized medical records from 86 patients who were treated with either vancomycin or metronidazole for their CDI. This real-world UK data was collected between April 2011-March 2012. The study also included prospective data, collected from 62 CDI patients who were treated with fidaxomicin between August 2012-July 2013.

All included CDI cases were matched to control cases by age, financial year, and healthcare resource use.

Predictably, the patients hospitalized with CDI had significantly higher healthcare costs than the control hospital patients. Broken down by CDI treatment received, the average amount spent per fidaxomicin patient was £10748, and £17451 per vancomycin/metronidazole patient.

The investigators found CDI recurrence was 6.5% for fidaxomicin recipients and 19.8% for patients who received vancomycin or metronidazole. Thus, an estimated 12 CDI recurrences were prevented by treatment with fidaxomicin.

A CDI recurrence raised the cost by an excess £8373 per fidaxomicin patient, and an excess £20249 per vancomycin/metronidazole patient. Notably, none of the fidaxomicin recipients had a third CDI recurrence.

This study found that although the fidaxomicin drug was initially more expensive, treating CDI patients with fidaxomicin saved an estimated £140292 overall, and £2125 per CDI.

“The lower rate of CDI recurrence associated with fidaxomicin compared with vancomycin or metronidazole as first-line treatment of CDI translates into real-world healthcare resource use savings,” the authors concluded. Now that COVID-19, seasonal respiratory viruses, and other illnesses are severely straining the healthcare system, it is crucial to optimize the resources used to combat an infection as prevalent as Clostridioides difficile.

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