BACKGROUND Recurrent Clostridioides difficile infections (CDIs) occur frequently and pose a substantial economic burden on the US healthcare system. The landscape for the treatment of CDI is evolving. AIM To elucidate the most cost-effective strategy for managing recurrent CDI. METHODS A decision tree analysis was created from a modified third-party payer's perspective to compare the cost-effectiveness of five strategies for patients experiencing their first CDI recurrence: oral vancomycin, fidaxomicin, fecal microbiota transplant (FMT) via colonoscopy, FMT via oral capsules, and a one-time infusion of bezlotoxumab with vancomycin. Effectiveness measures were quality-adjusted life years (QALY). A willingness-to-pay (WTP) threshold of $100,000 per QALY was set. One-way and probabilistic sensitivity analyses were performed. RESULTS Base-case analysis showed that FMT via colonoscopy was associated with the lowest cost at $5250 and that FMT via capsules was also a cost-effective strategy with an incremental cost-effectiveness ratio (ICER) of $31205/QALY. Sensitivity analyses demonstrated that FMT delivered by oral capsules and colonoscopy was comparable cost-effective modalities. At its current cost and effectiveness, bezlotoxumab was not a cost-effective strategy. CONCLUSIONS FMT via oral capsules and colonoscopy is both cost-effective strategies to treat the first recurrence of CDI. Further real-world economic studies are needed to understand the cost-effectiveness of all available strategies.

中文翻译：

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通过结肠镜检查和胶囊进行粪便移植是治疗复发性艰难梭菌感染的经济有效策略。

背景技术艰难梭状芽胞杆菌反复感染（CDI）经常发生，并给美国医疗保健系统带来巨大的经济负担。CDI的治疗领域正在发展。目的阐明用于管理经常性CDI的最具成本效益的策略。方法从修改后的第三方付款人的角度创建决策树分析，以比较五种策略首次经历CDI复发的患者的成本-效果：万古霉素，非达索霉素，通过结肠镜检查的粪便菌群移植（FMT），通过胶囊的FMT ，以及将贝佐洛单抗与万古霉素一次性输注一次。有效性指标为质量调整生命年（QALY）。每个QALY的付款意愿（WTP）阈值为100,000美元。进行了单向和概率敏感性分析。结果基本病例分析显示，通过结肠镜检查进行FMT的成本最低，为5250美元，而通过胶囊进行FMT也是一种成本有效的策略，其成本效益比（ICER）为31205美元/ QALY。敏感性分析表明，口服胶囊和结肠镜检查所提供的FMT是可比的具有成本效益的方式。就目前的成本和有效性而言，贝洛酮单抗不是一种具有成本效益的策略。结论通过口服胶囊和结肠镜检查进行FMT都是治疗CDI首次复发的经济有效策略。需要进一步的现实世界经济研究，以了解所有可用策略的成本效益。