Cost-Effectiveness of Fidaxomicin, Vancomycin in C. difficile Treatment


Therapies used to treat C. difficile shouldn’t be chosen based on economic factors but rather on recurrence risk.

Kelly Reveles, PhD, University of Texas Health Science Center at San Antonio

Dr Kelly Reveles

Kelly Reveles, PhD

For first-line treatment in patients with Clostridium difficile (C. difficile) associated diarrhea (CDAD), fidaxomicin was associated with similar total costs as vancomycin oral solution, according to a new study.

Researchers from the University of Texas at Austin, developed an analytic tool that would estimate total costs — including hospitalization and drug costs — in 5 patient populations with first line therapy treatment needs and up to 2 recurrent episodes.

The 5 CDAD treatment populations in the study were: the general population, elderly, patients receiving concomitant antibiotics, and patients with renal impairment or cancer.

The researchers thought that reducing CDAD by using fidaxomicin could reduce hospital readmissions and lead to lowering overall CDAD costs. Since studies to assess this link have been few and far between, most notably due to the therapy’s high drug acquisition cost, they wanted to compare the fidaxomicin costs and vancomycin costs from a hospital perspective.

The investigators estimated the total cost of fidaxomicin for first-line use in the general population for CDAD treatment was $14,442 per patient, compared to $14,179 per patient when treated with vancomycin first-line.

In both of these treatment groups, the initial hospitalization cost for CDAD comprised the majority of the cost. In the elderly population and those with renal impairment, using vancomycin saved hospitals between $243 and $371 per patient. However, fidaxomicin was the lower cost plan for patients with cancer and those using concomitant antibiotics, saving hospitals $616 and $312, respectively.

In these 2 groups, the cost savings may be attributed to the more significant differences in initial clinical cure, which could favor fidaxomicin in these cases.

In recurrent CDAD models, using fidaxomicin had “little impact” on total costs, the researchers observed.

If a patient was treated with vancomycin first-line, but fidaxomicin was used in the recurrent treatment, total costs rose from $14,179 to $14,229. When fidaxomicin was used for the first recurrence only or the first and second recurrences, the totals increased from $14,442 to $14,471 or $14,481, respectively.

“Cost savings associated with fidaxomicin are largely attributable to lower recurrence rates leading to fewer re-hospitalizations,” study author Kelly Reveles, PhD, told MD Magazine. “The results emphasize the importance of selecting initial CDAD therapy in the hospital setting based on recurrence risk, rather than solely on drug acquisition costs.”

Despite higher drug costs in the fidaxomicin treatment, the overall costs were offset because the therapy reduced hospital readmissions due to recurrent episodes. For these patients, the most significant costs were hospitalization costs, not the overall drug costs.

The researchers also noted that for their study, they considered oral vancomycin compounded from intravenous powder as their treatment pathway. They commented that hospitals, which use commercially available oral vancomycin capsules, might find a different cost benefit with fidaxomicin than what they concluded in the current study. The same may be true for hospitals that use combination vancomycin plus metronidazole therapy.

“This economic evaluation supports the use of fidaxomicin as first-line therapy for CDAD, especially in patients who are at high-risk for recurrence,” Dr. Reveles concluded.

The paper, titled “Fidaxomicin versus Vancomycin as a First-Line Treatment for Clostridium difficile-Associated Diarrhea (CDAD) in Specific Patient Populations: A Pharmacoeconomic Evaluation,” was published in the journal Pharmacotherapy: The Journal of Human Pharmacology and Drug Therapy.

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