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FMT Cost-Effective for 90% of Recurrent C Difficile Infections

Compared to fidaxomicin and vancomycinfecal, microbiota transplant (FMT) was the most cost-effective treatment for first and subsequent recurrent C difficile infection.

Fecal microbiota transplantation (FMT) is recommended by the American College of Gastroenterology and the Infectious Disease Society of America (IDSA) to treat recurrent Clostridioides difficile infection (CDI). Recurrent CDI is not only associated with high rates of patient mortality, but also drains hospital resources.

Data suggest FMT has a high cure rate when administered for the first recurrent CDI. However, how cost effective is FMT?

One study, published in Clinical Infectious Diseases, sought to answer this question by assessing the cost efficacy of FMT for first recurrent CDI. The study developed a Markov model to simulate patients presenting with initial CDI. With this model, the investigators analyzed the cost, efficacy, and cost-effectiveness of various IDSA-recommended CDI treatments. One of these recommendations included the option of FMT for a patient’s first recurrent CDI.

The Markov model stratified the simulated cohort by severity of initial CDI and estimated cure, recurrence, and mortality rates. The data were extracted from IDSA guidelines and published research detailing real-world FMT treatment outcomes. The primary outcomes were quality-adjusted life years, costs, and incremental cost-effectiveness ratios.

The investigators found that when FMT is available for first recurrent CDI, fidaxomicin is the most cost-effective treatment for initial non-severe CDI. Vancomycin was the optimum cost-effective option for initial severe CDI, and FMT was the most cost-effective for first and subsequent recurrent CDI.

“The most effective therapies for CDI are also the cost effective therapies,” said Radha Rajasingham, MD, a co-author of the study, assistant professor of medicine at the University of Minnesota Medical School, and infectious disease physician at M Health Fairview.

The incremental cost-effectiveness ratio of FMT was $27135/quality-adjusted life years. After conducting probabilistic sensitivity analysis at a $100000 cost-effectiveness threshold, the investigators found FMT for first and subsequent CDI recurrence was cost-effective 90% of the time (accounting for parameter uncertainty).

“Based on this analysis, we would recommend that rather than waiting for multiple recurrent CDI, providers should consider FMT use for any recurrent CDI,” said Byron Vaugn, MD, MS, an associate professor at the University of Minnesota Medical School, gastroenterologist at M Health Fairview, and a coauthor of the study. Current guidelines suggest FMT as a last resort for people with recurrent CDI, but it may be better utilized earlier to prevent further CDIs.

The study authors concluded that fecal microbiota transplant is a cost-effective strategy for first recurrent CDI. They recommended future study into FMT to reduce all recurrent CDI, or even as a primary CDI preventative strategy in high-risk individuals. The cost of FMT is warranted, given its efficacy and reduction of future expensive, timely, and potentially fatal C difficile infections.