Journal article
Cost-effectiveness analysis of initial treatment strategies for mild-to-moderate Clostridium difficile infection in hospitalized patients
American journal of health-system pharmacy, Vol.75(15), pp.1110-1121
08/01/2018
DOI: 10.2146/ajhp170554
PMID: 29903711
Abstract
The cost-effectiveness of initial treatment strategies for mild-to-moderate
infection (CDI) in hospitalized patients was evaluated.
Decision-analytic models were constructed to compare initial treatment with metronidazole, vancomycin, and fidaxomicin. The primary model included 1 recurrence, and the secondary model included up to 3 recurrences. Model variables were extracted from published literature with costs based on a healthcare system perspective. The primary outcome was the incremental cost-effective ratio (ICER) between initial treatment strategies.
In the primary model, the overall percentage of patients cured was 94.23%, 95.19%, and 96.53% with metronidazole, vancomycin, and fidaxomicin, respectively. Expected costs per case were $1,553.01, $1,306.62, and $5,095.70, respectively. In both models, vancomycin was more effective and less costly than metronidazole, resulting in negative ICERs. The ICERs for fidaxomicin compared with those for metronidazole and vancomycin in the primary model were $1,540.23 and $2,828.69 per 1% gain in cure, respectively. Using these models, a hospital currently treating initial episodes of mild-to-moderate CDI with metronidazole could expect to save $246.39-$388.37 per case treated by using vancomycin for initial therapy.
A decision-analytic model revealed vancomycin to be cost-effective, compared with metronidazole, for treatment of initial episodes of mild-to-moderate CDI in adult inpatients. From the hospital perspective, initial treatment with vancomycin resulted in a higher probability of cure and a lower probability of colectomy, recurrence, persistent recurrence, and cost per case treated, compared with metronidazole. Use of fidaxomicin was associated with an increased probability of cure compared with metronidazole and vancomycin, but at a substantially increased cost.
Details
- Title: Subtitle
- Cost-effectiveness analysis of initial treatment strategies for mild-to-moderate Clostridium difficile infection in hospitalized patients
- Creators
- Diana C Ford - Department of Pharmaceutical Care, University of Iowa Hospitals and Clinics, Iowa City, IAMary C Schroeder - Division of Health Services Research, University of Iowa College of Pharmacy, Iowa City, IADilek Ince - Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IAErika J Ernst - Division of Health Services Research, University of Iowa College of Pharmacy, Iowa City, IA erika-ernst@uiowa.edu
- Resource Type
- Journal article
- Publication Details
- American journal of health-system pharmacy, Vol.75(15), pp.1110-1121
- DOI
- 10.2146/ajhp170554
- PMID
- 29903711
- ISSN
- 1079-2082
- eISSN
- 1535-2900
- Language
- English
- Date published
- 08/01/2018
- Academic Unit
- Infectious Diseases; Pharmacy Practice and Science; Internal Medicine
- Record Identifier
- 9984094318402771
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