Cost-effectiveness analysis of fidaxomicin versus vancomycin in Clostridium difficile infection

Dilip Nathwani, Oliver A Cornely, Anke K Van Engen, Olatunji Odufowora-Sita, Peny Retsa, Isaac A O Odeyemi, Dilip Nathwani, Oliver A Cornely, Anke K Van Engen, Olatunji Odufowora-Sita, Peny Retsa, Isaac A O Odeyemi

Abstract

Objectives: Fidaxomicin was non-inferior to vancomycin with respect to clinical cure rates in the treatment of Clostridium difficile infections (CDIs) in two Phase III trials, but was associated with significantly fewer recurrences than vancomycin. This economic analysis investigated the cost-effectiveness of fidaxomicin compared with vancomycin in patients with severe CDI and in patients with their first CDI recurrence.

Methods: A 1 year time horizon Markov model with seven health states was developed from the perspective of Scottish public healthcare providers. Model inputs for effectiveness, resource use, direct costs and utilities were obtained from published sources and a Scottish expert panel. The main model outcome was the incremental cost-effectiveness ratio (ICER), expressed as cost per quality-adjusted life year (QALY), for fidaxomicin versus vancomycin; ICERs were interpreted using willingness-to-pay thresholds of £20,000/QALY and £30,000/QALY. One-way and probabilistic sensitivity analyses were performed.

Results: Total costs were similar with fidaxomicin and vancomycin in patients with severe CDI (£14,515 and £14,344, respectively) and in patients with a first recurrence (£16,535 and £16,926, respectively). Improvements in clinical outcomes with fidaxomicin resulted in small QALY gains versus vancomycin (severe CDI, +0.010; patients with first recurrence, +0.019). Fidaxomicin was cost-effective in severe CDI (ICER £16,529/QALY) and dominant (i.e. more effective and less costly) in patients with a first recurrence. The probability that fidaxomicin was cost-effective at a willingness-to-pay threshold of £30,000/QALY was 60% for severe CDI and 68% in a first recurrence.

Conclusions: Fidaxomicin is cost-effective in patients with severe CDI and in patients with a first CDI recurrence versus vancomycin.

Keywords: antibacterials; economic; model.

© The Author 2014. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy.

Figures

Figure 1.
Figure 1.
Markov model structure. Definitions of transition states are provided in Table 1. Note: expanded model details shown for fidaxomicin arm only. tx, treatment; VAN, vancomycin.
Figure 2.
Figure 2.
Probabilistic sensitivity analysis: ICER scatter plots for patients with (a) severe CDI and (b) first CDI recurrence. WTP, willingness to pay.
Figure 3.
Figure 3.
Cost-effectiveness acceptability curves for patients with (a) severe CDI and (b) first CDI recurrence. WTP, willingness to pay.

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