OBJECTIVES

The aim of this study was to systematically identify and evaluate economic evaluations comparing faecal microbiota transplantation (FMT) with antibiotic treatment for patients with recurrent Clostridioides difficile infection (rCDI).

METHODS

For inclusion in the systematic review, studies had to be peer-reviewed full economic evaluations comparing FMT with any antibiotic treatment strategy for rCDI. Studies including only costs or consequences, conference abstracts, and reviews were excluded. The following databases were searched through September 2018; PubMed, Embase, the Cochrane Library, Cinahl, Scopus, EconLit, and the NHS Economic Evaluation Database.

RESULTS

A total of 84 different studies were identified through the literature search. We included five research articles (published 2014-2017) that fulfilled the eligibility criteria. All of the studies were decision-analytic models with 78 days to lifelong time horizons. Overall, the studies compared FMT with vancomycin. Furthermore, some of the studies included metronidazole, fidaxomicin, and different delivery modes of FMT (enema, nasoduodenal infusion, and colonoscopy). All studies included QALYs as the effectiveness measure, using utility estimates based on populations with other gastrointestinal conditions, which were assumed to reflect the utility of patients with rCDI. The perspective for the different analyses was reported in four studies, differing between a societal perspective (two studies), third-party payer and the public healthcare system. In all studies, FMT was associated with larger benefits than antibiotics. Inconsistency was found regarding the direction of incremental costs. Considering the reported willingness-to-pay thresholds between approximately US$ 35,000-50,000, in all studies, FMT was considered cost-effective relative to antibiotic treatment. The results were heterogenous considering the delivery mode of FMT.

CONCLUSIONS

Studies indicate that FMT offers a cost-effective alternative to antibiotic treatment with vancomycin, metronidazole, or fidaxomicin for patients with rCDI. There is a need to establish the cost-effectiveness with utility-estimates from the specific patient population with rCDI.