Economic Evaluation of Fecal Microbiota Transplantation for The Treatment of Recurrent Clostridium Difficile Infection In Australia

Background and aim: Clostridium difficile is the most common cause of hospital-acquired diarrhoea in Australia. In 2013, a randomised controlled trial demonstrated the effectiveness of faecal microbiota transplantation (FMT) for the treatment of recurrent Clostridium difficile infection (CDI). The aim of this study is to evaluate the cost-effectiveness of faecal microbiota transplantation-via either nasoduodenal or colorectal delivery-compared with vancomycin for the treatment of recurrent CDI in Australia METHODS: A Markov model was developed to compare the cost-effectiveness of faecal microbiota transplantation compared with standard antibiotic therapy. A literature review of clinical evidence informed the structure of the model and the choice of parameter values. Clinical effectiveness was measured in terms of quality adjusted life years. Uncertainty in the model was explored using probabilistic sensitivity analysis. Results: Both nasoduodenal and colorectal FMT resulted in improved quality of life and reduced cost compared with vancomycin. The incremental effectiveness of either FMT delivery compared with vancomycin was 1.2 (95% CI: 0.1, 2.3) QALYs, or 1.4 (95% CI: 0.4, 2.4) life years saved. Treatment with vancomycin resulted in an increased cost of AU$4,094 (95% CI: AU$26, AU$8,161) compared with nasoduodenal delivery of FMT and AU$4,045 (95% CI: -AU$33, AU$8,124) compared with colorectal delivery. The mean difference in cost between colorectal and nasoduodenal FMT was not significant. Conclusions: If FMT, rather than vancomycin, became standard care for recurrent CDI in Australia, the estimated national healthcare savings would be over AU$4,000 per treated person, with a substantial increase in quality of life.