Universität zu Köln

Cornely, Oliver A., Watt, Maureen, McCrea, Charles, Goldenberg, Simon D. and De Nigris, Enrico (2018). Extended-pulsed fidaxomicin versus vancomycin for Clostridium difficile infection in patients aged >= 60 years (EXTEND): analysis of cost-effectiveness. J. Antimicrob. Chemother., 73 (9). S. 2529 - 2540. OXFORD: OXFORD UNIV PRESS. ISSN 1460-2091

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Abstract

Objectives: The randomized Phase IIIb/IV EXTEND trial showed that extended-pulsed fidaxomicin significantly improved sustained clinical cure and reduced recurrence versus vancomycin in patients >= 60 years old with Clostridium difficile infection (CDI). Cost-effectiveness of extended-pulsed fidaxomicin versus vancomycin as first-line therapy for CDI was evaluated in this patient population. Methods: Clinical results from EXTEND and inputs from published sources were used in a semi-Markov treatment-sequence model with nine health states and a 1 year time horizon to assess costs and QALYs. The model was based on a healthcare system perspective (NHS and Personal Social Services) in England. Sensitivity analyses were performed. Results: Patients receiving first-line extended-pulsed fidaxomicin treatment had a 0.02 QALY gain compared with first-line vancomycin (0.6267 versus 0.6038 QALYs/patient). While total drug acquisition costs were higher for extended-pulsed fidaxomicin than for vancomycin when used first-line (1356 pound versus 260 pound/patient), these were offset by lower total hospitalization costs (which also included treatment monitoring and community care costs; 10 pound 815 versus 11459 pound/patient) and lower costs of managing adverse events (694 pound versus 1199 pound/patient), reflecting the lower incidence of CDI recurrence and adverse events with extended-pulsed fidaxomicin. Extended-pulsed fidaxomicin cost 53 pound less per patient than vancomycin over 1 year. The probability that first-line extended-pulsed fidaxomicin was cost-effective at a willingness-to-pay threshold of 30 pound 000/QALY was 76% in these patients. Conclusions: While fidaxomicin acquisition costs are higher than those of vancomycin, the observed reduced recurrence rate with extended-pulsed fidaxomicin makes it a more effective and less costly treatment strategy than vancomycin for first-line treatment of CDI in older patients.

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Cornely, Oliver A. UNSPECIFIED UNSPECIFIED UNSPECIFIED Watt, Maureen UNSPECIFIED UNSPECIFIED UNSPECIFIED McCrea, Charles UNSPECIFIED UNSPECIFIED UNSPECIFIED Goldenberg, Simon D. UNSPECIFIED UNSPECIFIED UNSPECIFIED De Nigris, Enrico UNSPECIFIED UNSPECIFIED UNSPECIFIED
URN:	urn:nbn:de:hbz:38-175035
DOI:	10.1093/jac/dky184
Journal or Publication Title:	J. Antimicrob. Chemother.
Volume:	73
Number:	9
Page Range:	S. 2529 - 2540
Date:	2018
Publisher:	OXFORD UNIV PRESS
Place of Publication:	OXFORD
ISSN:	1460-2091
Language:	English
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language LENGTH-OF-STAY; MORTALITY; OLDER Multiple languages Infectious Diseases; Microbiology; Pharmacology & Pharmacy Multiple languages
Refereed:	Yes
URI:	http://kups.ub.uni-koeln.de/id/eprint/17503