BURDEN OF CLOSTRIDIOIDES DIFFICILE INFECTION (CDI) IN PATIENTS AT HIGH RISK OF RECURRENCE IN SPAIN
Author(s)
Elena Reigadas, PhD1, Miguel Salavert Lletí, MD2, David Cantarero Prieto, PhD3, Elena Vizcaya, Ms4, Sandra Rodríguez, Ms4, Carla Garí-Peris, Ms5, Javier Cobo, MD6.
1Servicio de Microbiología Clínica y Enfermedades Infecciosas, Hospital G.U. Gregorio Marañón, Madrid, Spain, 2Unidad de Enfermedades Infecciosas.Hospital Universitario y Politécnico La Fe, Valencia, Spain. Grupo de Investigación en "Infección Grave" del Instituto de Investigación Sanitaria La Fe (IIS-La Fe), Valencia, Spain, 3Universidad de Cantabria, SANFI e IDIVAL Valdecilla, Santander, Spain, 4Tillotts Pharma Iberia (Spain & Portugal), Barcelona, Spain, 5Outcomes'10 (A ProductLife Group Company), Castellón de la Plana, Spain, 6Servicio de Enfermedades Infecciosas, Hospital Universitario Ramón y Cajal, IRYCIS, CIBERINFEC, Madrid, Spain.
1Servicio de Microbiología Clínica y Enfermedades Infecciosas, Hospital G.U. Gregorio Marañón, Madrid, Spain, 2Unidad de Enfermedades Infecciosas.Hospital Universitario y Politécnico La Fe, Valencia, Spain. Grupo de Investigación en "Infección Grave" del Instituto de Investigación Sanitaria La Fe (IIS-La Fe), Valencia, Spain, 3Universidad de Cantabria, SANFI e IDIVAL Valdecilla, Santander, Spain, 4Tillotts Pharma Iberia (Spain & Portugal), Barcelona, Spain, 5Outcomes'10 (A ProductLife Group Company), Castellón de la Plana, Spain, 6Servicio de Enfermedades Infecciosas, Hospital Universitario Ramón y Cajal, IRYCIS, CIBERINFEC, Madrid, Spain.
OBJECTIVES: Recurrent Clostridioides difficile infection (rCDI) is a major driver of disease burden, associated with increased morbidity, mortality, and healthcare resource use. This study aimed to quantify the clinical and economic burden of CDI in high-risk patients of recurrence (≥65 years and comorbidities or immunosuppression) and to estimate the benefits of reducing recurrence rates from the perspective of the Spanish National Health System (NHS).
METHODS: A cohort-based Markov model was developed to simulate CDI progression over a 1-year horizon using 15-day cycles. The model included six health states: initial CDI, clinical cure, clinical failure, recurrence, global cure, and death. A cohort aged ≥65 years with healthcare-associated and community-acquired CDI (n=24,482) was modelled. Two scenarios were compared: standard clinical practice (vancomycin-based) and an alternative using Spanish real-world evidence on fidaxomicin. Clinical inputs, utilities, and costs were derived from Spanish published literature and validated by experts. Outcomes included recurrences, mortality, hospitalisation days, Quality-Adjusted Life Years (QALYs), and direct healthcare costs (€, 2025). One-way sensitivity analyses were conducted.
RESULTS: Compared with the standard clinical practice, the fidaxomicin-based scenario reduced total recurrences by 65.5% (5,380 vs 1,856), including reductions in first (-59.8%), second (-78.3%), and third recurrences (-85.6%), and decreased the number of patients experiencing ≥1 recurrence by 59.3%. These clinical improvements translated into a 15.6% reduction in hospitalisation days (284,640 vs 240,299) and a 3.3% reduction in mortality. Total QALYs for the cohort increased by 1.8% (16,594 vs 16,889). Total costs decreased by 11.1%, corresponding to approximately €34.2 million in annual savings, of which 95.9% were attributable to recurrence-related costs. Results were robust in sensitivity analyses.
CONCLUSIONS: Treatments with lower recurrence rates, such as fidaxomicin compared with vancomycin, substantially lower clinical burden, healthcare resource utilization, and costs in high-risk patients in Spain. Reducing CDI recurrence may therefore improve outcomes and generate significant savings for the Spanish NHS.
METHODS: A cohort-based Markov model was developed to simulate CDI progression over a 1-year horizon using 15-day cycles. The model included six health states: initial CDI, clinical cure, clinical failure, recurrence, global cure, and death. A cohort aged ≥65 years with healthcare-associated and community-acquired CDI (n=24,482) was modelled. Two scenarios were compared: standard clinical practice (vancomycin-based) and an alternative using Spanish real-world evidence on fidaxomicin. Clinical inputs, utilities, and costs were derived from Spanish published literature and validated by experts. Outcomes included recurrences, mortality, hospitalisation days, Quality-Adjusted Life Years (QALYs), and direct healthcare costs (€, 2025). One-way sensitivity analyses were conducted.
RESULTS: Compared with the standard clinical practice, the fidaxomicin-based scenario reduced total recurrences by 65.5% (5,380 vs 1,856), including reductions in first (-59.8%), second (-78.3%), and third recurrences (-85.6%), and decreased the number of patients experiencing ≥1 recurrence by 59.3%. These clinical improvements translated into a 15.6% reduction in hospitalisation days (284,640 vs 240,299) and a 3.3% reduction in mortality. Total QALYs for the cohort increased by 1.8% (16,594 vs 16,889). Total costs decreased by 11.1%, corresponding to approximately €34.2 million in annual savings, of which 95.9% were attributable to recurrence-related costs. Results were robust in sensitivity analyses.
CONCLUSIONS: Treatments with lower recurrence rates, such as fidaxomicin compared with vancomycin, substantially lower clinical burden, healthcare resource utilization, and costs in high-risk patients in Spain. Reducing CDI recurrence may therefore improve outcomes and generate significant savings for the Spanish NHS.
Conference/Value in Health Info
2026-11, ISPOR Europe 2026, Vienna, Austria
Value in Health, Volume 29, Issue 12S
Code
CO55
Topic
Clinical Outcomes, Economic Evaluation
Topic Subcategory
Comparative Effectiveness or Efficacy
Disease
Infectious Disease (non-vaccine)