Vancomycin Most Cost-Effective Treatment for Recurrent C. difficile

The most cost-effective treatment for treating recurrent Clostridium difficile (C. difficile) infection appears to be vancomycin, according to new research.

Researchers from the Cleveland Clinic analyzed 3 possible C. difficile infection treatments in order to determine the most cost-effective course of action for recurrent infections. Despite most studies reporting C. difficile recurrence rates between 10% and 30%, the researchers wrote that the standard of care for recurrent cases is less clear than it is for initial infections. By analyzing the cost effectiveness of oral vancomycin, fidaxomicin, or bezlotoxumab plus vancomycin, the researchers sought to provide insight into the most efficient use of healthcare resources.

The investigators created a 1-year model from the payer’s perspective, which was comprised of a comparison of the 3 treatments. The model calculated quality-adjusted life years (QALY) and incremental cost-effective ratios. The study authors reviewed the current literature to find clinical, utility, and cost data. In order to classify a treatment as cost effective, the researchers set the willingness to pay threshold at $100,000 per QALY gained.

Across the 3 methods, vancomycin alone was the lowest cost per patient at $15,692 and was linked to a quality-adjusted life year gain of 0.8019 years.

In a Peer Exchange video with MD Magazine®, Peter Salgo, MD, who was not involved in the Cleveland Clinic study, mentioned that if the price between vancomycin and fidaxomicin were the same, the preference might be fidaxomicin.

“We would like to give fidaxomicin to everybody. If the price were the same, maybe we would,” said Salgo. “But vancomycin still works, right? What about the folks who, no matter what they had as a first treatment, come back with recurrent C. difficile? At this point, do you go to vancomycin, or does everybody get fidaxomicin? And if you’re going to use vancomycin, how do you use it?”

Watch the physicians’ discussion to see the rest of the panel’s opinions on the debate between effective fidaxomicin vs. vancomycin treatments, and what off-label uses they might have.

In the Cleveland Clinic study, fidaxomicin ranked second, costing $17,047 per patient annually with a quality-adjusted life year gain of 0.8046 years. Despite this higher quality-adjusted life year increase, the cost was well above the willingness-to-pay threshold. The study authors wrote that even at a willingness-to-pay threshold of $500,000 per QALY year gained, fidaxomicin likely still would not have been as cost effective as vancomycin.

The combination of bezlotoxumab plus vancomycin cost the payer $18,475 annually and gained 0.8039 quality-adjusted life years. It still ranked third when researchers upped the willingness-to-pay threshold to $500,000 per quality-adjusted life year gained.

The study authors added that several recently published papers agreed with their findings. One study demonstrated that vancomycin was more cost effective in treating C. difficile infection than fidaxomicin, while another produced a similar result. Neither of those studies examined the effects of bezlotoxumab plus vancomycin, which is why the study authors decided to include the treatment strategy in their research.

The paper, titled “Cost-effectiveness of three different strategies for the treatment of first recurrent Clostridium difficile infection diagnosed in a community setting,” was published in Infection Control & Hospital Epidemiology.