OBJECTIVES:  The aim of this study was to estimate the cost-effectiveness of oral fidaxomicin versus oral vancomycin for the treatment of clostridium difficile infections (CDIs) in patients aged 16 years or older. METHODS: We conducted a decision analytic model comparing fidaxomicin with vancomycin for treatment of CDIs based on the Egyptian current clinical practice. The model probabilities and utilities were derived from the available published sources. Direct medical costs were obtained from Ministry of health lists. Probabilistic sensitivity analysis (PSA) was conducted. No discounting was performed. RESULTS:  The total quality-adjusted life-years (QALYs) of fidaxomicin was estimated to be 0.7986, whereas that of the vancomycin was estimated to be 0.7659 (with a net difference of 0.0327 QALYs). The total costs for fidaxomicin and vancomycin were 2335.97 EGP and 2182.69 EGP respectively (with a net difference of 153.28 EGP). Thus the incremental cost-effectiveness ratio (ICER) for fidaxomicin was EGP 4684.33 /QALY. Results from PSA indicate that the fidaxomicin had a 99% chance of being cost-effective at our EGP 70,000 per QALY threshold. CONCLUSIONS:  Compared with commonly accepted willingness-to-pay threshold in Egypt, the results of the model showed that fidaxomicin is cost effective option for the treatment of CDIs when compared with oral vancomycin .