Presentation (CTI)

OBJECTIVES: Fecal microbiota transplantation (FMT) therapy significantly improved clinical response in constipation-predominant irritable bowel syndrome (IBS-C). We aimed to perform a cost-effectiveness analysis of FMT in patients with moderate-to-severe IBS-C from the perspective of US payer.
METHODS: A Markov model was developed to compare the outcomes of two treatment strategies in a hypothetical cohort of IBS-C patients: (1) FMT therapy (60 grams) via gastroscopy, and (2) standard drug treatment. The model employed a one-year time horizon with monthly cycle. Primary outcomes included direct medical costs and quality-adjusted life-years (QALYs) gained. Clinical inputs were estimated from data of clinical trials. Utility values were derived from findings of a US observational cohort study of health utilities in IBS patients. Cost inputs, including FMT, medications, and outpatient care, were sourced from literature and national databases. One-way and probabilistic sensitivity analyses were conducted.
RESULTS: Comparing to standard treatment, FMT was expected to gain incremental 0.0159 QALYs with cost-saving of USD7,813. The incremental net monetary benefit of FMT was USD8,609. One-way sensitivity analysis identified that base-case results were most sensitive to variations in the FMT and standard treatment response, utility values for responders and non-responders, and FMT cost. No influential variable with threshold value was identified. Probabilistic sensitivity analysis showed that FMT had a 99.91% probability of being cost-effective at a willingness-to-pay threshold of 50,000 USD/QALY.
CONCLUSIONS: Compared to standard drug treatment, FMT is likely an effective and cost-saving option for IBS-C patients with moderate-to-severe symptoms.