Is fidaxomicin worth the cost? An economic analysis.

TitleIs fidaxomicin worth the cost? An economic analysis.
Publication TypeJournal Article
Year of Publication2013
AuthorsBartsch SM, Umscheid CA, Fishman N, Lee BY
JournalClin Infect Dis
Volume57
Issue4
Pagination555-61
Date Published2013 Aug
ISSN1537-6591
KeywordsAdolescent, Adult, Aged, Aged, 80 and over, Aminoglycosides, Anti-Bacterial Agents, Clostridium difficile, Clostridium Infections, Cost-Benefit Analysis, Female, Health Care Costs, Humans, Male, Middle Aged, Young Adult
Abstract

BACKGROUND: In May 2011, the Food and Drug Administration approved fidaxomicin for the treatment of Clostridium difficile infection (CDI). It has been found to be noninferior to vancomycin; however, its cost-effectiveness for the treatment of CDI remains undetermined.METHODS: We developed a decision analytic simulation model to determine the economic value of fidaxomicin for CDI treatment from the third-party payer perspective. We looked at CDI treatment in these 3 cases: (1) no fidaxomicin, (2) only fidaxomicin, and (3) fidaxomicin based on strain typing results.RESULTS: The incremental cost-effectiveness ratio for fidaxomicin based on screening given current conditions was >$43.7 million per quality-adjusted life-year and using only fidaxomicin was dominated (ie, more costly and less effective) by the other 2 treatment strategies explored. The fidaxomicin strategy tended to remain dominated, even at lower costs. With approximately 50% of CDI due to the NAP1/BI/027 strain, a course of fidaxomicin would need to cost ≤$150 to be cost-effective in the treatment of all CDI cases and between $160 and $400 to be cost-effective for those with a non-NAP1/BI/027 strain (ie, treatment based on strain typing).CONCLUSIONS: Given the current cost and NAP1/BI/027 accounting for approximately 50% of isolates, using fidaxomicin as a first-line treatment for CDI is not cost-effective. However, typing and treatment with fidaxomicin based on strain may be more promising depending on the costs of fidaxomicin.

DOI10.1093/cid/cit346
Alternate JournalClin. Infect. Dis.
PubMed ID23704121
PubMed Central IDPMC3719891
Grant List1U54GM088491-0109 / GM / NIGMS NIH HHS / United States
U54 GM088491 / GM / NIGMS NIH HHS / United States
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