Maureen Watt1, Aurélien Dinh2, Alban Le Monnier3, Patrick Tilleul4. 1. a Health Economics and Outcomes Research, Astellas Pharma EMEA , Chertsey , UK. 2. b Département de Médecine Aiguë Spécialisée , Hopital Raymond Poincaré , Garches , France. 3. c Microbiologie Clinique, Groupe Hospitalier Paris Saint-Joseph , Paris , France. 4. d Pharmacie à Usage Intérieur, Groupe Hospitalier Pitié-Salpêtrière AP-HP , Paris , France.
Abstract
BACKGROUND: Fidaxomicin is a macrocyclic antibiotic with proven efficacy against Clostridium difficile infection (CDI) in adults. It was licensed in France in 2012, but, due to higher acquisition costs compared with existing treatments, healthcare providers require information on its cost/benefit profile. OBJECTIVE: To compare healthcare costs and health outcomes of fidaxomicin and vancomycin, as reference treatment for CDI. METHODS: A Markov model was used to simulate the treatment pathway, over 1 year, of adult patients with CDI receiving fidaxomicin or vancomycin. Several patient sub-groups (severe CDI; recurrent CDI; concomitant antibiotics; cancer; renal failure; elderly) were evaluated. Cost-effectiveness was analyzed based on cure and recurrence rates derived from published randomized clinical trials comparing fidaxomicin and vancomycin, and costs calculated from the payer perspective using French hospitalization data and drug cost databases. Model outputs included costs in euros (reference year 2014) and health outcomes (recurrence; sustained cure rates). Alternative scenario and sensitivity analyses were performed using data from other clinical trials in CDI, including one conducted in real-life clinical practice in France. RESULTS: Drug acquisition costs were €1,692 higher in fidaxomicin-treated patients, but this was offset by the lower hospitalization costs with fidaxomicin, which were reduced by €1,722. The reduction in the cost of hospitalization was driven by the significantly lower number of recurrences in fidaxomicin-treated patients, offsetting the acquisition cost of fidaxomicin in all sub-groups except recurrent CDI and concomitant antibiotics. CONCLUSION: This study demonstrated that, despite higher acquisition costs, the lower recurrence rate with fidaxomicin resulted in cost savings or low incremental costs compared with vancomycin.
BACKGROUND:Fidaxomicin is a macrocyclic antibiotic with proven efficacy against Clostridium difficileinfection (CDI) in adults. It was licensed in France in 2012, but, due to higher acquisition costs compared with existing treatments, healthcare providers require information on its cost/benefit profile. OBJECTIVE: To compare healthcare costs and health outcomes of fidaxomicin and vancomycin, as reference treatment for CDI. METHODS: A Markov model was used to simulate the treatment pathway, over 1 year, of adult patients with CDI receiving fidaxomicin or vancomycin. Several patient sub-groups (severe CDI; recurrent CDI; concomitant antibiotics; cancer; renal failure; elderly) were evaluated. Cost-effectiveness was analyzed based on cure and recurrence rates derived from published randomized clinical trials comparing fidaxomicin and vancomycin, and costs calculated from the payer perspective using French hospitalization data and drug cost databases. Model outputs included costs in euros (reference year 2014) and health outcomes (recurrence; sustained cure rates). Alternative scenario and sensitivity analyses were performed using data from other clinical trials in CDI, including one conducted in real-life clinical practice in France. RESULTS: Drug acquisition costs were €1,692 higher in fidaxomicin-treated patients, but this was offset by the lower hospitalization costs with fidaxomicin, which were reduced by €1,722. The reduction in the cost of hospitalization was driven by the significantly lower number of recurrences in fidaxomicin-treated patients, offsetting the acquisition cost of fidaxomicin in all sub-groups except recurrent CDI and concomitant antibiotics. CONCLUSION: This study demonstrated that, despite higher acquisition costs, the lower recurrence rate with fidaxomicin resulted in cost savings or low incremental costs compared with vancomycin.
Authors: Gabriel J Escobar; Jennifer M Baker; Patricia Kipnis; John D Greene; T Christopher Mast; Swati B Gupta; Nicole Cossrow; Vinay Mehta; Vincent Liu; Erik R Dubberke Journal: Infect Control Hosp Epidemiol Date: 2017-08-24 Impact factor: 3.254
Authors: Regina Lamendella; Justin R Wright; Jada Hackman; Christopher McLimans; David R Toole; William Bernard Rubio; Rebecca Drucker; Hoi Tong Wong; Kate Sabey; John P Hegarty; David B Stewart Journal: mSphere Date: 2018-01-10 Impact factor: 4.389
Authors: Oliver A Cornely; Maureen Watt; Charles McCrea; Simon D Goldenberg; Enrico De Nigris Journal: J Antimicrob Chemother Date: 2018-09-01 Impact factor: 5.790