Cost-effectiveness analysis of a fecal microbiota transplant center for treating recurrent C.difficile infection

Seth R Shaffer; Julia Witt; Laura E Targownik; Dina Kao; Christine Lee; Fabrice Smieliauskas; David T Rubin; Harminder Singh; Charles N Bernstein

doi:10.1016/j.jinf.2020.09.025

Cost-effectiveness analysis of a fecal microbiota transplant center for treating recurrent C.difficile infection

J Infect. 2020 Nov;81(5):758-765. doi: 10.1016/j.jinf.2020.09.025. Epub 2020 Sep 24.

Authors

Seth R Shaffer¹, Julia Witt², Laura E Targownik³, Dina Kao⁴, Christine Lee⁵, Fabrice Smieliauskas⁶, David T Rubin⁷, Harminder Singh⁸, Charles N Bernstein⁹

Affiliations

¹ Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada; University of Manitoba IBD Clinical and Research Center, Winnipeg, Manitoba, Canada; Inflammatory Bowel Disease Center, University of Chicago Medicine, Chicago, USA.
² Department of Economics, University of Manitoba, Winnipeg, Manitoba, Canada.
³ Division of Gastroenterology, Department of Medicine, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada.
⁴ Division of Gastroenterology, Department of Medicine, University of Alberta, Edmonton, Alberta.
⁵ Hamilton Regional Laboratory Medicine Program, Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada; Department of Pathology and Laboratory Medicine, University of British Columbia, British Columbia, Canada.
⁶ Economics, Wayne State University, Detroit, MI, USA; Pharmacy Practice, Wayne State University, Detroit, MI, USA.
⁷ Inflammatory Bowel Disease Center, University of Chicago Medicine, Chicago, USA.
⁸ Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada; University of Manitoba IBD Clinical and Research Center, Winnipeg, Manitoba, Canada.
⁹ Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada; University of Manitoba IBD Clinical and Research Center, Winnipeg, Manitoba, Canada. Electronic address: charles.bernstein@umanitoba.ca.

PMID: 32980389
DOI: 10.1016/j.jinf.2020.09.025

Abstract

Objective: We assessed the cost-effectiveness of establishing a fecal microbial transplant (FMT) unit in Canada for the treatment of recurrent CDI.

Design: We performed a cost-effectiveness analysis to determine the number of patients with recurrent CDI needed to treat (NNT) annually to make establishing a FMT unit cost-effective. We compared treating patients for their second recurrence of CDI with FMT in a jurisdiction with a FMT unit, compared to being treated with antibiotics; then sent to a medical center with FMT available for the third recurrence. We used a willingness to pay threshold of $50,000 per quality-adjusted-life-year gained.

Results: The minimum annual NNT was 15 for FMT via colonoscopy, 17 for FMT via capsule, and 44 for FMT via enema compared with vancomycin, and 16, 18, and 47 compared with fidaxomicin, respectively. A medical center's minimum catchment area when establishing a FMT unit would have to be 56,849 if using FMT via colonoscopy, or 64,429 if using capsules.

Conclusion: We report the minimum number of patients requiring treatment annually with FMT to achieve cost-effectiveness, when including start-up and ongoing costs. FMT is cost-effective in Canada in populations with a sufficient number of eligible patients, ranging from 15 to 47 depending on the FMT modality used. This is crucial for medical jurisdictions making decisions about establishing a FMT unit for the treatment of recurrent CDI. The cost-effectiveness can be generalized in other countries.

Keywords: C difficile; Cost effectiveness analysis; Fecal microbiota transplantation; Fidaxomicin; Vancomycin.

MeSH terms

Anti-Bacterial Agents / therapeutic use
Clostridioides difficile*
Clostridium Infections* / drug therapy
Cost-Benefit Analysis
Fecal Microbiota Transplantation
Humans
Microbiota*
Recurrence
Treatment Outcome
Vancomycin

Substances

Anti-Bacterial Agents
Vancomycin