OBJECTIVES: Clostridium difficile infection (CDI) caused by ribotype 002 strain is associated with poor outcomes in Hong Kong. Fecal microbiota transplantation (FMT) is an effective but costly treatment for CDI. We aimed to examine potential cost-effectiveness of ribotype-guided FMT in patients with initial CDI from the perspective of healthcare provider in Hong Kong.

METHODS: A decision-analytic model was designed to simulate outcomes of ribotype-guided FMT versus standard treatment (metronidazole) in patients with initial CDI in the hospital setting. Outcome measures included incidences of recurrence CDI, refractory CDI and mortality; direct medical cost; and quality-adjusted life year (QALY) loss for CDI. Sensitivity analysis was performed to examine robustness of base-case results.

RESULTS: Comparing to standard treatment in base-case analysis, ribotype-guided FMT group reduced mortality (11.4% versus 17.1%), refractory (17.1% versus 17.3%), recurrence CDI (16.4% versus 16.6%), cost (USD9,018 versus USD10,199) (USD1=HKD7.8), and saved 0.486 QALYs. One-way sensitivity analysis found the ribotype-guided FMT group to remain cost-effective when patient acceptance rate of FMT was >0.6% and ribotype 002 prevalence was >0.07%. In probabilistic sensitivity analysis, ribotype-guided FMT gained higher QALYs at 100% of simulations with mean QALY gain of 0.400 QALYs (95%CI: 0.395-0.405; p<0.001). The ribotype-guided group was less costly in 99.86% of time, and mean cost-saving was USA967 (95% CI: 957-977; p<0.001).

CONCLUSIONS: Ribotype-guided FMT appears to be effective and cost-saving in patients with initial CDI in Hong Kong. The cost-effectiveness of ribotype-guided FMT is subject to patient acceptance of FMT and prevalence of ribotype with high risk for poor outcomes.