The Ongoing Challenge of Clostridioides Difficile Infection in Austria: Economic Evaluation of Two Recommended Treatment Pathways
Author(s)
Evelyn Walter, PhD1, Marco Voit, MSc1, Gerald Eichhober, MSc1, Gordon Spencer, PhD2, Lei Wang, PhD2, Vanessa Stadlbauer-Köllner, MD, MBA3.
1Institute for Pharmaeconomic Research, Vienna, Austria, 2Tillotts Pharma AG, Rheinfelden, Switzerland, 3Medical University of Graz, Graz, Austria.
1Institute for Pharmaeconomic Research, Vienna, Austria, 2Tillotts Pharma AG, Rheinfelden, Switzerland, 3Medical University of Graz, Graz, Austria.
OBJECTIVES: Clostridioides difficile (CD) is a significant nosocomial pathogen associated with severe, potentially life-threatening clostridioides difficile infections (CDI), particularly following disruption of the gut microbiota. Transmission occurs via the fecal-oral route through resilient spores. While most infections are acquired in hospitals or long-term care settings, 20-30% occur in outpatient environments. In 2025, the estimated number of adult CDI cases in Austria is between 900 and 1,000. This economic analysis is a comparison of current clinical practice which is based on reimbursement limitations regarding the Austrian reimbursement codex (EKO) (reference-pathway) versus the new Austrian guideline from the Austrian Society of Gastroenterology and Hepatology (ÖGGH), which recommends use of fidaxomicin (Dificlir®) as first-line therapy (ÖGGH-pathway).
METHODS: A decision-tree model was developed to reflect the CDI treatment-pathway. Each patient could undergo up to three successive treatments per infection episode to achieve a response and may experience up to two recurrences. Treatment duration was fixed at 10 days according to clinical guidelines. Model inputs—including patient characteristics, treatment response rates, recurrence probabilities, utilities, CDI-related mortality, and healthcare costs (2025€)—were sourced from published literature and validated by clinical experts. The model was evaluated over the patients’ remaining lifetime from the perspective of the Austrian healthcare-system. Deterministic and probabilistic sensitivity analyses were performed.
RESULTS: The average lifetime cost per patient was €4,081.46 for the ÖGGH-pathway and €4,085.77 for the reference-pathway, resulting in incremental savings of €4.31 (€252.56 additional treatment costs offset by €256.87 savings). The ÖGGH-strategy also produced better health outcomes, with 0.10 additional QALYs (7.01 versus 6.91) and a survival gain of 0.17 life years (10.75 versus 10.58). This resulted in a dominant incremental-cost-utility-ratio (ICUR) of -€43.11 per QALY gained.
CONCLUSIONS: The ÖGGH guideline is the dominant strategy, providing improved health outcomes at lower costs, and represents a cost-effective option for CDI management in Austria.
METHODS: A decision-tree model was developed to reflect the CDI treatment-pathway. Each patient could undergo up to three successive treatments per infection episode to achieve a response and may experience up to two recurrences. Treatment duration was fixed at 10 days according to clinical guidelines. Model inputs—including patient characteristics, treatment response rates, recurrence probabilities, utilities, CDI-related mortality, and healthcare costs (2025€)—were sourced from published literature and validated by clinical experts. The model was evaluated over the patients’ remaining lifetime from the perspective of the Austrian healthcare-system. Deterministic and probabilistic sensitivity analyses were performed.
RESULTS: The average lifetime cost per patient was €4,081.46 for the ÖGGH-pathway and €4,085.77 for the reference-pathway, resulting in incremental savings of €4.31 (€252.56 additional treatment costs offset by €256.87 savings). The ÖGGH-strategy also produced better health outcomes, with 0.10 additional QALYs (7.01 versus 6.91) and a survival gain of 0.17 life years (10.75 versus 10.58). This resulted in a dominant incremental-cost-utility-ratio (ICUR) of -€43.11 per QALY gained.
CONCLUSIONS: The ÖGGH guideline is the dominant strategy, providing improved health outcomes at lower costs, and represents a cost-effective option for CDI management in Austria.
Conference/Value in Health Info
2025-11, ISPOR Europe 2025, Glasgow, Scotland
Value in Health, Volume 28, Issue S2
Code
EE718
Topic
Clinical Outcomes, Economic Evaluation
Topic Subcategory
Value of Information
Disease
Gastrointestinal Disorders, Infectious Disease (non-vaccine)