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; Cherng-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

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, Cherng-Hsun Chiu^*, Chee Jen Chang^*

^*Corresponding author for this work

Research output: Contribution to journal › Journal Article › peer-review

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.

Original language	English
Article number	1229148
Journal	Frontiers in Medicine
Volume	10
DOIs	https://doi.org/10.3389/fmed.2023.1229148
State	Published - 2023

Bibliographical note

Publisher Copyright:
Copyright © 2023 Lan, Le, Chiu, Chen, Yeh, Cheng, Kuo, Chen, Chen, Yeh, Chiu and Chang.

Keywords

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

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.3389/fmed.2023.1229148

Cite this

Lan, K. Y., Le, P. H., Chiu, C. T., Chen, C. C., Yeh, Y. M., Cheng, H. T., Kuo, C. J., Chen, C. L., Chen, Y. C., Yeh, P. J., Chiu, C.-H., & Chang, C. J. (2023). Fecal microbiota transplantation for treatment of refractory or recurrent Clostridioides difficile infection in Taiwan: a cost-effectiveness analysis. Frontiers in Medicine, 10, Article 1229148. https://doi.org/10.3389/fmed.2023.1229148

@article{c54d029917024690bbcfaf4070b06b4c,

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

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",

author = "Lan, {Kai Yen} and Le, {Puo Hsien} and Chiu, {Cheng Tang} and Chen, {Chien Chang} and Yeh, {Yuan Ming} and Cheng, {Hao Tsai} and Kuo, {Chia Jung} and Chen, {Chyi Liang} and Chen, {Yi Ching} and Yeh, {Pai Jui} and Cherng-Hsun Chiu and Chang, {Chee Jen}",

note = "Publisher Copyright: Copyright {\textcopyright} 2023 Lan, Le, Chiu, Chen, Yeh, Cheng, Kuo, Chen, Chen, Yeh, Chiu and Chang.",

year = "2023",

doi = "10.3389/fmed.2023.1229148",

language = "英语",

volume = "10",

journal = "Frontiers in Medicine",

issn = "2296-858X",

publisher = "Frontiers Media SA",

}

TY - JOUR

T1 - Fecal microbiota transplantation for treatment of refractory or recurrent Clostridioides difficile infection in Taiwan

T2 - a cost-effectiveness analysis

AU - Lan, Kai Yen

AU - Le, Puo Hsien

AU - Chiu, Cheng Tang

AU - Chen, Chien Chang

AU - Yeh, Yuan Ming

AU - Cheng, Hao Tsai

AU - Kuo, Chia Jung

AU - Chen, Chyi Liang

AU - Chen, Yi Ching

AU - Yeh, Pai Jui

AU - Chiu, Cherng-Hsun

AU - Chang, Chee Jen

PY - 2023

Y1 - 2023

N2 - 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.

AB - 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.

KW - Clostridioides difficile

KW - cost-effectiveness analysis

KW - economic evaluation

KW - fecal microbiota transplantation

KW - fidaxomicin

KW - inflammatory bowel disease

KW - vancomycin

UR - http://www.scopus.com/inward/record.url?scp=85174221832&partnerID=8YFLogxK

U2 - 10.3389/fmed.2023.1229148

DO - 10.3389/fmed.2023.1229148

M3 - 文章

AN - SCOPUS:85174221832

SN - 2296-858X

VL - 10

JO - Frontiers in Medicine

JF - Frontiers in Medicine

M1 - 1229148

ER -

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

Abstract

Bibliographical note

Keywords

UN SDGs

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