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A Review of the Economics of Treating Clostridium difficile Infection

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Abstract

Clostridium difficile infection (CDI) is a costly result of antibiotic use, responsible for an estimated 14,000 deaths annually in the USA according to the Centers for Disease Control and Prevention. Annual costs attributable to CDI are in excess of $US1 billion. This review summarizes appropriate utilization of prevention and treatment methods for CDI that have the potential to reduce the economic and humanistic costs of the disease. Some cost-effective strategies to prevent CDI include screening and isolation of hospital admissions based on C. difficile carriage to reduce transmission in the inpatient setting, and probiotics, which are potentially efficacious in preventing CDI in the appropriate patient population. The most extensively studied agents for treatment of CDI are metronidazole, vancomycin, and fidaxomicin. Most economic comparisons between metronidazole and vancomycin favor vancomycin, especially with the emergence of metronidazole-resistant C. difficile strains. Metronidazole can only be recommended for mild disease. Moderate to severe CDI should be treated with vancomycin, preferably the compounded oral solution, which provides the most cost-effective therapeutic option. Fidaxomicin offers a clinically effective and potentially cost-effective alternative for treating moderate CDI in patients who do not have the NAP1/BI/027 strain of C. difficile. Probiotics and fecal microbiota transplant have variable efficacy and the US FDA does not currently regulate the content; the potential economic advantages of these treatment modalities are currently unknown.

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Acknowledgments

This manuscript is the result of work supported in part by resources and the use of facilities at the Veterans Affairs Western New York Healthcare System. The contents of this manuscript are not intended to represent the views of the Department of Veterans Affairs or the US Government.

Kari Mergenhagen has no relevant conflicts of interest to disclose.

Amy Wojciechowski has no relevant conflicts of interest to disclose.

Joseph Paladino has no relevant conflicts of interest to disclose.

Kari Mergenhagen and Amy Wojciechowski performed the initial literature search, wrote and prepared the manuscript for submission, and responded to reviewer comments and requests for revisions. Joseph Paladino contributed to the conceptualization and design of the review article and helped with editing and revisions of the manuscript. Senior author, Joseph Paladino, serves as the overall guarantor of the content of this manuscript.

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Authors and Affiliations

  1. Veterans Affairs Western New York Healthcare System, 3495 Bailey Avenue, Buffalo, NY, 14215, USA

    Kari A. Mergenhagen & Amy L. Wojciechowski

  2. University at Buffalo School of Pharmacy and Pharmaceutical Sciences, 213 Kapoor Hall, Buffalo, NY, 14214, USA

    Joseph A. Paladino

  3. CPL Associates, LLC, Buffalo, NY, 14226, USA

    Joseph A. Paladino

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  1. Kari A. Mergenhagen
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  2. Amy L. Wojciechowski
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  3. Joseph A. Paladino
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Correspondence to Amy L. Wojciechowski.

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Mergenhagen, K.A., Wojciechowski, A.L. & Paladino, J.A. A Review of the Economics of Treating Clostridium difficile Infection. PharmacoEconomics 32, 639–650 (2014). https://doi.org/10.1007/s40273-014-0161-y

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