Introduction

Fidaxomicin is as effective as vancomycin in treating Clostridioides difficile infection (CDI) but more effective at preventing recurrence. However, because fidaxomicin is more costly than vancomycin, its overall value in managing CDI is not well understood. This study assessed the budget impact of introducing fidaxomicin versus vancomycin for the treatment of adults with CDI from a hospital perspective in the US.

Methods

A cohort-based decision analytic model was developed over a 1-year horizon. A hospital with 10,000 annual hospitalizations was simulated. The model considered two adult populations: patients with no prior CDI episode and patients with one prior CDI episode. Two scenarios were assessed per population: 15% fidaxomicin/85% vancomycin use and 100% vancomycin use. Model inputs were obtained from published sources and expert opinion. Model outcomes included cost, payment, and revenue at the hospital level, per treated CDI patient, and per admitted patient. Budget impact was calculated as the difference in revenue between scenarios. One-way sensitivity analyses tested the effects of varying model inputs on the budget impact.

Results

In patients with no prior CDI episode, treatment with fidaxomicin resulted in potential savings over 1 year of $1105 at the hospital level, $14 per treated CDI patient, and $0.11 per admitted patient. In patients with one prior CDI episode, fidaxomicin use was associated with potential savings over 1 year of $1150 at the hospital level, $74 per treated CDI patient, and $0.12 per admitted patient. Savings were driven by a reduced rate of CDI recurrence with fidaxomicin treatment and uptake of fidaxomicin. Sensitivity analyses indicated savings when inputs were varied in most scenarios.

Conclusion

Budgetary savings can be achieved with fidaxomicin due to reduced CDI recurrence as a result of a superior sustained clinical response. Our results support considering the broader benefits of fidaxomicin, beyond its cost, when making formulary inclusion decisions.

中文翻译：

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美国非达霉素与万古霉素治疗艰难梭菌感染的预算影响分析

介绍

Fidaxomicin 在治疗艰难梭菌感染 (CDI)方面与万古霉素一样有效，但在预防复发方面更有效。然而，由于非达霉素比万古霉素更昂贵，它在治疗 CDI 方面的总体价值尚不清楚。本研究从美国医院的角度评估了引入非达霉素与万古霉素治疗成人 CDI 的预算影响。

方法

一个基于队列的决策分析模型是在 1 年内开发的。模拟了一家年住院人数为 10,000 人次的医院。该模型考虑了两个成年人群：以前没有 CDI 发作的患者和以前有过一次 CDI 发作的患者。每个人群评估了两种情况：15% 非达霉素/85% 万古霉素使用和 100% 万古霉素使用。模型输入来自已发表的资料和专家意见。模型结果包括医院层面、每位接受治疗的 CDI 患者和每位入院患者的成本、付款和收入。预算影响被计算为情景之间的收入差异。单向敏感性分析测试了不同模型输入对预算影响的影响。

结果

对于既往没有 CDI 发作的患者，使用非达霉素治疗可在医院层面节省 1105 美元，每位接受治疗的 CDI 患者 14 美元，每位入院患者 0.11 美元，从而在 1 年内节省潜在成本。在有 1 次 CDI 发作的患者中，使用非达霉素与 1 年内在医院层面潜在节省 1150 美元、每位接受治疗的 CDI 患者 74 美元和每位入院患者 0.12 美元相关。使用非达霉素治疗和服用非达霉素降低了 CDI 复发率，从而节省了费用。敏感性分析表明，在大多数情况下输入不同时可以节省。

结论

由于卓越的持续临床反应减少了 CDI 复发，因此非达霉素可以节省预算。我们的结果支持在制定处方纳入决定时考虑非达霉素的更广泛益处，而不是其成本。