Fecal Microbiota Transplant Found Cost-Effective in Patients With Refractory, Recurrent Clostridioides Difficile Infection

A recent study indicates that fecal microbiota transplant (FMT) is a cost-effective alternative to antibiotics for patients with clostridiodes difficile infections (CDI) and inflammatory bowel disease (IBD). For the study, the authors evaluated the costs of FMT with vancomycin and fidaxomicin in patients with recurrent CDI with and without IBD.

Patients with IBD have an increased risk of CDI and typically have worse outcomes versus patients who do not have IBD. Although antibiotics are an effective treatment option, evidence indicates that FMT holds promise in treating refractory or recurrent CDI.

FMT, which is still a relatively new treatment option, involves extracting feces from healthy donors to rebuild the gut microbiota of a diseased patients. FMT is delivered via upper or lower endoscopy with enemas or capsules.

Recently, FMT has become one of the main treatments for recurrent CDI, with cure rates of up to 88%. Additionally, FMT demonstrated greater efficacy than the antibiotics commonly used to treat CDI, which has led to a new class of live microbiota therapeutics.

Prior data show that human metabolic profiles could be influenced by the treatment, according to the current study. However, the cost-effectiveness of FMT for the treatment of recurrent CDI has yet to be evaluated in patients with IBD and recurrent CDI.

The comparative study analyzed the cost and efficacy of different treatments using a Markov model with deterministic and probalistic sensitivity analyses. The study evaluated the cost and clinical outcomes of FMT through colonoscopy versus antibiotics that are commonly used to treat CDI—vancomycin and fidaxomicin­—using data from Chang Gung Memorial Hospital, Linkou Branch in Taiwan.

The study showed that FMT was cost-effective versus vancomycin in the general CDI cohort, in addition to a subset of patients with IBD (NT$1,101,971.98/quality-adjusted life year [QALY] gained in overall patients; NT$1,833,719.14/QALY gained in IBD patients). However, these findings were not consistent compared with fidaxomicin.

In this comparison, FMT was only found cost-effective overall in patients with rCDI (NT$567,133.45/QALY gained) but showed a slight increase in QALY in the IBD subset of patients (0.0018 QALY gained).

“FMT is cost-effective, compared to vancomycin or fidaxomicin for treatment of rCDI in most scenarios from payer's perspective in Taiwan,” the study authors wrote. “These findings can help health authorities to create reimbursement policy for FMT in rCDI.”

A study conducted by researchers from Michigan State University presented at the 2022 American College of Gastroenterology Meeting found that initial research supports the use of FMT as a treatment for IBD. In this study, the authors evaluated multiple databases for randomized controlled trials among patients with active IBD who received FMT compared to placebo.

The efficacy analysis showed that clinical (OR, 1.506; 95% CI, 1.259-1.803), P <0.0001), endoscopic (OR, 2.335; 95% CI, 1.577-3.457, P <0.0001), and histologic (OR, 3.764; 95% CI, 1.986-7.136; P <0.001) remission were consistent with prior findings.

References

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 Chiu, Cheng-Hsun and Chang, Chee-Jen, Cost-Effectiveness Analysis of Fecal Microbiota Transplantation for Treatment of Refractory or Recurrent Clostridioides Difficile Infection in Taiwan. Available at http://dx.doi.org/10.2139/ssrn.4356859. Accessed March 6, 2023.