Is fidaxomicin worth the cost? An economic analysis

Clin Infect Dis. 2013 Aug;57(4):555-61. doi: 10.1093/cid/cit346. Epub 2013 May 23.

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.

Keywords: Clostridium difficile; cost; economics; fidaxomicin; treatment.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Aminoglycosides / economics*
  • Aminoglycosides / therapeutic use*
  • Anti-Bacterial Agents / economics*
  • Anti-Bacterial Agents / therapeutic use*
  • Clostridium Infections / drug therapy*
  • Clostridium Infections / microbiology
  • Clostridium difficile / isolation & purification*
  • Cost-Benefit Analysis
  • Female
  • Fidaxomicin
  • Health Care Costs
  • Humans
  • Male
  • Middle Aged
  • Young Adult

Substances

  • Aminoglycosides
  • Anti-Bacterial Agents
  • Fidaxomicin