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Cost-Effectiveness of Competing Treatment Strategies for Clostridium difficile Infection: A Systematic Review

Published online by Cambridge University Press:  21 February 2018

Phuc Le ,
Van T. Nghiem ,
Patricia Dolan Mullen  and
Abhishek Deshpande
Phuc Le
Affiliation:
Center for Value-Based Care Research, Medicine Institute, Cleveland Clinic, Cleveland, Ohio
Van T. Nghiem
Affiliation:
Department of Management, Policy and Community Health, The University of Texas School of Public Health, Houston, Texas
Patricia Dolan Mullen
Affiliation:
Department of Health Promotion and Behavioral Sciences, Center for Health Promotion and Prevention Research, The University of Texas School of Public Health, Houston, Texas
Abhishek Deshpande*
Affiliation:
Center for Value-Based Care Research, Medicine Institute, Cleveland Clinic, Cleveland, Ohio Department of Infectious Disease, Medicine Institute, Cleveland Clinic, Cleveland, Ohio
*
Address correspondence to Abhishek Deshpande MD, PhD, Center for Value-based Care Research, Medicine Institute, Cleveland Clinic, 9500 Euclid Ave, G10, Cleveland, OH 44195 ([email protected]).
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Abstract

BACKGROUND

Clostridium difficile infection (CDI) presents a substantial economic burden and is associated with significant morbidity. While multiple treatment strategies have been evaluated, a cost-effective management strategy remains unclear.

OBJECTIVE

We conducted a systematic review to assess cost-effectiveness analyses of CDI treatment and to summarize key issues for clinicians and policy makers to consider.

METHODS

We searched PubMed and 5 other databases from inception to August 2016. These searches were not limited by study design or language of publication. Two reviewers independently screened the literature, abstracted data, and assessed methodological quality using the Drummond and Jefferson checklist. We extracted data on study characteristics, type of CDI, treatment characteristics, and model structure and inputs.

RESULTS

We included 14 studies, and 13 of these were from high-income countries. More than 90% of these studies were deemed moderate-to-high or high quality. Overall, 6 studies used a decision-tree model and 7 studies used a Markov model. Cost of therapy, time horizon, treatment cure rates, and recurrence rates were common influential factors in the study results. For initial CDI, fidaxomicin was a more cost-effective therapy than metronidazole or vancomycin in 2 of 3 studies. For severe initial CDI, 2 of 3 studies found fidaxomicin to be the most cost-effective therapy. For recurrent CDI, fidaxomicin was cost-effective in 3 of 5 studies, while fecal microbiota transplantation (FMT) by colonoscopy was consistently cost-effective in 4 of 4 studies.

CONCLUSIONS

The cost-effectiveness of fidaxomicin compared with other pharmacologic therapies was not definitive for either initial or recurrent CDI. Despite its high cost, FMT by colonoscopy may be a cost-effective therapy for recurrent CDI. A consensus on model design and assumptions are necessary for future comparison of CDI treatment.

Infect Control Hosp Epidemiol 2018;39:412–424

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 39 , Issue 4 , April 2018 , pp. 412 - 424
Copyright
© 2018 by The Society for Healthcare Epidemiology of America. All rights reserved 

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References

REFERENCES

1. Loo, VG, Poirier, L, Miller, MA, et al. A predominantly clonal multi-institutional outbreak of Clostridium difficile-associated diarrhea with high morbidity and mortality. N Engl J Med 2005;353:2442–2449.Google Scholar
2. Lessa, FC, Winston, LG, McDonald, LC, Emerging Infections Program C. difficile Surveillance Team. Burden of Clostridium difficile infection in the United States. N Engl J Med 2015;372:2369–2370.Google Scholar
3. Cohen, SH, Gerding, DN, Johnson, S, et al. Clinical practice guidelines for Clostridium difficile infection in adults: 2010 update by the society for healthcare epidemiology of America (SHEA) and the infectious diseases society of America (IDSA). Infect Control Hosp Epidemiol 2010;31:431–455.Google Scholar
4. O’Connor, JR, Johnson, S, Gerding, DN. Clostridium difficile infection caused by the epidemic BI/NAP1/027 strain. Gastroenterology 2009;136:1913–1924.Google Scholar
5. McFarland, LV. Alternative treatments for Clostridium difficile disease: what really works? J Med Microbiol 2005;54:101–111.CrossRefGoogle ScholarPubMed
6. Eyre, DW, Walker, AS, Wyllie, D, et al. Predictors of first recurrence of Clostridium difficile infection: implications for initial management. Clin Infect Dis 2012;55(Suppl 2):S77–S87.Google Scholar
7. Kelly, CP. Can we identify patients at high risk of recurrent Clostridium difficile infection? Clin Microbiol Infect 2012;18(Suppl 6):21–27.CrossRefGoogle ScholarPubMed
8. Desai, K, Gupta, SB, Dubberke, ER, Prabhu, VS, Browne, C, Mast, TC. Epidemiological and economic burden of Clostridium difficile in the United States: estimates from a modeling approach. BMC Infect Dis 2016;16:303.Google Scholar
9. Debast, SB, Bauer, MP, Kuijper, EJ, European Society of Clinical Microbiology and Infectious Diseases. European Society of Clinical Microbiology and Infectious Diseases: update of the treatment guidance document for Clostridium difficile infection. Clin Microbiol Infect 2014;20(Suppl 2):1–26.Google Scholar
10. Bakken, JS, Borody, T, Brandt, LJ, et al. Treating Clostridium difficile infection with fecal microbiota transplantation. Clin Gastroenterol Hepatol 2011;9:1044–1049.CrossRefGoogle ScholarPubMed
11. Surawicz, CM, Brandt, LJ, Binion, DG, et al. Guidelines for diagnosis, treatment, and prevention of Clostridium difficile infections. Am J Gastroenterol 2013;108:478–498; quiz 499.CrossRefGoogle ScholarPubMed
12. Bartsch, SM, Umscheid, CA, Fishman, N, Lee, BY. Is fidaxomicin worth the cost? An economic analysis. Clin Infect Dis 2013;57:555–561.Google Scholar
13. Konijeti, GG, Sauk, J, Shrime, MG, Gupta, M, Ananthakrishnan, AN. Cost-effectiveness of competing strategies for management of recurrent Clostridium difficile infection: a decision analysis. Clin Infect Dis 2014;58:1507–1514.Google Scholar
14. Lapointe-Shaw, L, Tran, KL, Coyte, PC, et al. Cost-effectiveness analysis of six strategies to treat recurrent Clostridium difficile infection. PLoS One 2016;11:e0149521.Google Scholar
15. Varier, RU, Biltaji, E, Smith, KJ, et al. Cost-effectiveness analysis of treatment strategies for initial Clostridium difficile infection. Clin Microbiol Infect 2014;20:1343–1351.Google Scholar
16. Varier, RU, Biltaji, E, Smith, KJ, et al. Cost-effectiveness analysis of fecal microbiota transplantation for recurrent Clostridium difficile infection. Infect Control Hosp Epidemiol 2015;36:438–444.CrossRefGoogle ScholarPubMed
17. Watt, M, McCrea, C, Johal, S, Posnett, J, Nazir, J. A cost-effectiveness and budget impact analysis of first-line fidaxomicin for patients with Clostridium difficile infection (CDI) in Germany. Infection 2016;44:599–606.CrossRefGoogle ScholarPubMed
18. Mergenhagen, KA, Wojciechowski, AL, Paladino, JA. A review of the economics of treating Clostridium difficile infection. Pharmacoeconomics 2014;32:639–650.Google Scholar
19. Moher, D, Liberati, A, Tetzlaff, J, Altman, DG, PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Ann Intern Med 2009;151:264–269.Google Scholar
20. Shea, BJ, Grimshaw, JM, Wells, GA, et al. Development of AMSTAR: a measurement tool to assess the methodological quality of systematic reviews. BMC Med Res Methodol 2007;7:10.CrossRefGoogle ScholarPubMed
21. Drummond, MF, Jefferson, TO. Guidelines for authors and peer reviewers of economic submissions to the BMJ. The BMJ Economic Evaluation Working Party. BMJ 1996;313:275–283.CrossRefGoogle Scholar
22. Husereau, D, Drummond, M, Petrou, S, et al. Consolidated Health Economic Evaluation Reporting Standards (CHEERS) statement. Value Health 2013;16:e1–e5.CrossRefGoogle ScholarPubMed
23. Consumer price indices. Organisation for Economic Co-operation and Development (OECD) website. http://stats.oecd.org/index.aspx?datasetcode=mei_prices. Accessed August 25, 2016.Google Scholar
24. Rubio-Terres, C, Cobo Reinoso, J, Grau Cerrato, S, et al. Economic assessment of fidaxomicin for the treatment of Clostridium difficile infection (CDI) in special populations (patients with cancer, concomitant antibiotic treatment or renal impairment) in Spain. Eur J Clin Microbiol Infect Dis 2015;34:2213–2223.CrossRefGoogle ScholarPubMed
25. Nathwani, D, Cornely, OA, Van Engen, AK, Odufowora-Sita, O, Retsa, P, Odeyemi, IA. Cost-effectiveness analysis of fidaxomicin versus vancomycin in Clostridium difficile infection. J Antimicrob Chemother 2014;69:2901–2912.Google Scholar
26. Merlo, G, Graves, N, Brain, D, Connelly, L. Economic evaluation of fecal microbiota transplantation for the treatment of recurrent Clostridium difficile infection in Australia. J Gastroenterol Hepatol 2016;31:1927–1932.Google Scholar
27. Stranges, PM, Hutton, DW, Collins, CD. Cost-effectiveness analysis evaluating fidaxomicin versus oral vancomycin for the treatment of Clostridium difficile infection in the United States. Value Health 2013;16:297–304.Google Scholar
28. Markovic, V, Kostic, M, Ilickovic, I, Jankovic, SM. Cost-effectiveness comparison of fidaxomicin and vancomycin for treatment of Clostridium difficile infection: a Markov model based on data from a South West Balkan country in socioeconomic transition. Value in Health Regional Issues 2014;4C:87–94.Google Scholar
29. Wagner, M, Lavoie, L, Goetghebeur, M. Clinical and economic consequences of vancomycin and fidaxomicin for the treatment of Clostridium difficile infection in Canada. Can J Infect Dis Med Microbiol 2014;25:87–94.Google Scholar
30. Perras, C, Tsakonas, E, Ndegwa, S, Conly, J, Valiquette, L, Farrah, K. Vancomycin or metronidazole for treatment of Clostridium difficile infection: clinical and economic analyses. Ottawa: Canadian Agency for Drugs and Technologies in Health; 2011 (Technology report; no. 136).Google Scholar
31. Gidengil, CA, Caloyeras, JP, Hanson, M, Hillestad, R, Mattke, S. Comparative effectiveness of fidaxomicin for treatment of Clostridium difficile infection. Am J Pharmacy Benefit 2014;6:161–170.Google Scholar
32. Cornely, OA, Crook, DW, Esposito, R, et al. Fidaxomicin versus vancomycin for infection with Clostridium difficile in Europe, Canada, and the USA: a double-blind, non-inferiority, randomised controlled trial. Lancet Infect Dis 2012;12:281–289.Google Scholar
33. Louie, TJ, Miller, MA, Mullane, KM, et al. Fidaxomicin versus vancomycin for Clostridium difficile infection. N Engl J Med 2011;364:422–431.CrossRefGoogle ScholarPubMed
34. Lee, CH, Steiner, T, Petrof, EO, et al. Frozen vs fresh fecal microbiota transplantation and clinical resolution of diarrhea in patients with recurrent Clostridium difficile infection: a randomized clinical trial. JAMA 2016;315:142–149.Google Scholar
35. van Nood, E, Vrieze, A, Nieuwdorp, M, et al. Duodenal infusion of donor feces for recurrent Clostridium difficile . N Engl J Med 2013;368:407–415.Google Scholar
36. Li, YT, Cai, HF, Wang, ZH, Xu, J, Fang, JY. Systematic review with meta-analysis: long-term outcomes of faecal microbiota transplantation for Clostridium difficile infection. Aliment Pharmacol Ther 2016;43:445–457.Google Scholar
37. Kassam, Z, Hundal, R, Marshall, JK, Lee, CH. Fecal transplant via retention enema for refractory or recurrent Clostridium difficile infection. Arch Intern Med 2012;172:191–193.Google Scholar
38. Kassam, Z, Lee, CH, Yuan, Y, Hunt, RH. Fecal microbiota transplantation for Clostridium difficile infection: systematic review and meta-analysis. Am J Gastroenterol 2013;108:500–508.Google Scholar
39. Hebbard, AIT, Slavin, MA, Reed, C, et al. Risks factors and outcomes of Clostridium difficile infection in patients with cancer: a matched case-control study. Support Care Cancer 2017;25:1923–1930.Google Scholar
40. Abrahamian, FM, Talan, DA, Krishnadasan, A, et al. Clostridium difficile infection among US emergency department patients with diarrhea and no vomiting. Ann Emerg Med 2017;70:19–27.Google Scholar
41. Bagdasarian, N, Rao, K, Malani, PN. Diagnosis and treatment of Clostridium difficile in adults: a systematic review. JAMA 2015;313:398–408.Google Scholar
42. Ananthakrishnan, AN, McGinley, EL, Binion, DG. Excess hospitalisation burden associated with Clostridium difficile in patients with inflammatory bowel disease. Gut 2008;57:205–210.Google Scholar
43. McDonald, EG, Milligan, J, Frenette, C, Lee, TC. Continuous proton pump inhibitor therapy and the associated risk of recurrent Clostridium difficile infection. JAMA Intern Med 2015;175:784–791.Google Scholar
44. Bell, CM, Urbach, DR, Ray, JG, et al. Bias in published cost-effectiveness studies: systematic review. BMJ 2006;332:699–703.Google Scholar
45. Garey, KW, Aitken, SL, Gschwind, L, et al. Development and validation of a Clostridium difficile health-related quality-of-life questionnaire. J Clin Gastroenterol 2016;50:631–637.Google Scholar
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