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Cost-effectiveness analysis of ribotype-guided fecal microbiota transplantation in Chinese patients with severe Clostridium difficile infection

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  • Minghuan Jiang
  • Nok-hang Leung
  • Margaret Ip
  • Joyce H S You

Abstract

Background: Clostridium difficile infection (CDI) caused by ribotype 002 strain is associated with poor outcomes in Chinese patients. Fecal microbiota transplantation (FMT) is an effective but costly treatment for CDI. We aimed to examine potential cost-effectiveness of ribotype-guided FMT in Chinese patients with severe CDI. Methods: A decision-analytic model was designed to simulate outcomes of ribotype 002-guided FMT versus vancomycin treatment in Chinese patients with severe CDI in the hospital setting. Outcome measures included mortality rate; direct medical cost; and quality-adjusted life year (QALY) loss for CDI. Sensitivity analysis was performed to examine robustness of base-case results. Results: Comparing to vancomycin treatment, ribotype-guided FMT group reduced mortality (11.6% versus 17.1%), cost (USD8,807 versus USD9,790), and saved 0.472 QALYs in base-case analysis. One-way sensitivity analysis found the ribotype-guided FMT group to remain cost-effective when patient acceptance rate of FMT was >0.6% and ribotype 002 prevalence was >0.07%. In probabilistic sensitivity analysis, ribotype-guided FMT gained higher QALYs at 100% of simulations with mean QALY gain of 0.405 QALYs (95%CI: 0.400–0.410; p

Suggested Citation

  • Minghuan Jiang & Nok-hang Leung & Margaret Ip & Joyce H S You, 2018. "Cost-effectiveness analysis of ribotype-guided fecal microbiota transplantation in Chinese patients with severe Clostridium difficile infection," PLOS ONE, Public Library of Science, vol. 13(7), pages 1-14, July.
    • Handle: RePEc:plo:pone00:0201539
    DOI: 10.1371/journal.pone.0201539
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    References listed on IDEAS

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    1. Lauren Lapointe-Shaw & Kim L Tran & Peter C Coyte & Rebecca L Hancock-Howard & Jeff Powis & Susan M Poutanen & Susy Hota, 2016. "Cost-Effectiveness Analysis of Six Strategies to Treat Recurrent Clostridium difficile Infection," PLOS ONE, Public Library of Science, vol. 11(2), pages 1-18, February.
    2. Emilie Baro & Tatiana Galperine & Fanette Denies & Damien Lannoy & Xavier Lenne & Pascal Odou & Benoit Guery & Benoit Dervaux, 2017. "Cost-Effectiveness Analysis of Five Competing Strategies for the Management of Multiple Recurrent Community-Onset Clostridium difficile Infection in France," PLOS ONE, Public Library of Science, vol. 12(1), pages 1-15, January.
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