A cost-effectiveness and budget impact analysis of first-line fidaxomicin for patients with Clostridium difficile infection (CDI) in Germany.

Abstract

PURPOSE:

Clostridium difficile infection (CDI) represents a significant economic healthcare burden, especially the cost of recurrent disease. Fidaxomicin produced significantly lower recurrence rates and higher sustained cure rates in clinical trials. We evaluated the cost-effectiveness and budget impact of fidaxomicin compared with vancomycin in Germany in the first-line treatment of patient subgroups with CDI at increased risk of recurrence.

METHODS:

A semi-Markov model was used to compare the cost-effectiveness and budget impact of fidaxomicin vs. vancomycin from a payer perspective in Germany. The model cycle length was 10 days. The time horizon was 1 year. Model inputs were probability of clinical cure, 30-day probability of recurrence, and 30-day attributable mortality based on evidence from two randomized controlled trials comparing fidaxomicin and vancomycin in patients with CDI. Cost-effectiveness outcomes were cost per quality-adjusted life year gained, cost per bed-day saved, and cost per recurrence avoided.

RESULTS:

Despite higher drug acquisition costs, fidaxomicin was dominant in the cancer subgroup (less costly and more effective) and cost-effective in the other subgroups, with incremental cost-effectiveness ratios vs. vancomycin ranging from €26,900 to €44,500. Hospitalization costs of the first-line treatment of CDI with fidaxomicin vs. vancomycin were lower in every patient subgroup, resulting in budget impacts ranging from -€1325 (in patients ≥65 years) to -€2438 (in cancer patients). Reductions in the cost of treating recurrence with fidaxomicin ranged from -€574.32 per patient in those receiving concomitant antibiotics to -€1500.68 per patient in renally impaired patients.

CONCLUSIONS:

In patient subgroups with CDI at increased recurrence risk, fidaxomicin was cost-effective vs. vancomycin, and less costly and more effective in patients with cancer.

• Authors: Maureen Watt, Charles McCrea, Sukhvinder Johal, John Posnett, Jameel Nazir
• Journal: Infection (Infection) Vol. 44 Issue 5 Pg. 599-606 (Oct 2016) ISSN: 1439-0973 [Electronic] Germany
• PMID: 27062378 (Publication Type: Journal Article)

Chemical References

• Aminoglycosides
• Anti-Bacterial Agents
• Fidaxomicin

Topics

• Aminoglycosides (economics, pharmacology, therapeutic use)
• Anti-Bacterial Agents (economics, pharmacology, therapeutic use)
• Clostridioides difficile (drug effects)
• Cost-Benefit Analysis
• Enterocolitis, Pseudomembranous (drug therapy, economics)
• Fidaxomicin
• Germany
• Humans
• Markov Chains
• Recurrence