Cost-effectiveness of faecal microbiota transplantation compared with vancomycin monotherapy for early Clostridioides difficile infection: economic evaluation alongside a randomized controlled trial

Abstract

Background: For Clostridioides difficile infection (CDI), faecal microbiota transplantation (FMT) is currently recommended for patients with three or more CDI episodes. A recent randomised controlled trial (RCT) show that FMT may be considered early, defined as intervention during the first or second CDI episode.

Aim: The aim was to investigate hospital costs of FMT as a complementary treatment compared with current standard care in patients with first or second CDI.

Findings: Compared with standard care for first or second CDI, patients randomised to FMT had €1,645 lower hospital costs over 26 weeks owing to fewer admissions and hospital contacts and less medication use. In the sensitivity analyses, FMT remained cost-effective as long as the treatment cost of FMT stayed below approximately €1,572 per component, corresponding to a total cost of FMT treatment (two components) of €3,144.

Conclusion: FMT was cost-effective with both lower costs and greater effectiveness than current standard care involving vancomycin monotherapy. The findings were robust to sensivity analyses, with a threshold cost for one FMT treatment consisting of two components of €3,144.

Keywords: Clostridioides difficile infection; Cost effectiveness; Faecal microbiota transplantation; Health economics.