Fecal microbiota transplantation for treatment of refractory or recurrent Clostridioides difficile infection in Taiwan: a cost-effectiveness analysis

Kai-Yen Lan; Puo-Hsien Le; Cheng-Tang Chiu; Chien-Chang Chen; Yuan-Ming Yeh; Hao-Tsai Cheng; Chia-Jung Kuo; Chyi-Liang Chen; Yi-Ching Chen; Pai-Jui Yeh; Cheng-Hsun Chiu; Chee-Jen Chang

doi:10.3389/fmed.2023.1229148

Fecal microbiota transplantation for treatment of refractory or recurrent Clostridioides difficile infection in Taiwan: a cost-effectiveness analysis

Front Med (Lausanne). 2023 Oct 2:10:1229148. doi: 10.3389/fmed.2023.1229148. eCollection 2023.

Authors

Kai-Yen Lan^#¹, Puo-Hsien Le^#^{2

3

4

5}, Cheng-Tang Chiu^{2

3

4}, Chien-Chang Chen^{4

6}, Yuan-Ming Yeh⁴, Hao-Tsai Cheng^{4

7}, Chia-Jung Kuo^{2

3

4}, Chyi-Liang Chen⁸, Yi-Ching Chen^{4

8

9}, Pai-Jui Yeh^{4

6}, Cheng-Hsun Chiu^{4

8

9}, Chee-Jen Chang^{1

10

11

12}

Affiliations

¹ Department of Biomedical Sciences, Chang Gung University College of Medicine, Taoyuan, Taiwan.
² Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan, Taiwan.
³ Taiwan Association of the Study of Small Intestinal Disease, Taoyuan, Taiwan.
⁴ Chang Gung Microbiota Therapy Center, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan, Taiwan.
⁵ Liver Research Center, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan, Taiwan.
⁶ Department of Pediatric Gastroenterology, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan, Taiwan.
⁷ Division of Gastroenterology and Hepatology, Department of Internal Medicine, New Taipei Municipal Tucheng Hospital, New Taipei City, Taiwan.
⁸ Molecular Infectious Disease Research Center, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan, Taiwan.
⁹ Division of Pediatric Infectious Diseases, Department of Pediatrics, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan, Taiwan.
¹⁰ Graduate Institute of Clinical Medicine, Chang Gung University College of Medicine, Taoyuan, Taiwan.
¹¹ Department of Obstetrics and Gynecology, Chang Gung Memory Hospital, Linko Branch, Taoyuan, Taiwan.
¹² Research Service Center for Health Informatics, Chang Gung University, Taoyuan, Taiwan.

^# Contributed equally.

Abstract

Background: Compared to antibiotic treatment, fecal microbiota transplantation (FMT) is a more effective treatment for refractory or recurrent CDI (rCDI). Patients with inflammatory bowel disease (IBD) have a higher incidence of CDI and worse outcomes. There has been no study from Asia to evaluate the cost-effectiveness of FMT for overall rCDI patients and rCDI patients with IBD.

Methods: We applied a Markov model with deterministic and probabilistic sensitivity analyses to evaluate the cost and effectiveness of different treatments for rCDI patients with a time horizon of 1 year from the payer's perspective. We compared the cost and clinical outcomes of FMT through colonoscopy to two antibiotics (vancomycin and fidaxomicin) using data from Chang Gung Memorial Hospital, Taoyuan, Taiwan.

Results: Compared to vancomycin, FMT was cost-effective in overall rCDI patients as well as IBD patients with rCDI [USD 39356 (NT$1,101,971.98)/quality-adjusted life year (QALY) gained in overall patients; USD65490 (NT$1,833,719.14)/QALY gained in IBD patients]. Compared to fidaxomicin, FMT was only cost-effective in overall rCDI patients [USD20255 (NT$567,133.45)/QALY gained] but slightly increased QALY (0.0018 QALY gained) in IBD patients with rCDI.

Conclusion: FMT is cost-effective, compared to vancomycin or fidaxomicin, for the treatment of rCDI in most scenarios from the payers' perspective in Taiwan.

Keywords: Clostridioides difficile; cost-effectiveness analysis; economic evaluation; fecal microbiota transplantation; fidaxomicin; inflammatory bowel disease; vancomycin.