OBJECTIVES: The incidence and financial burden associated with recurrent Clostridioides difficile infection (rCDI) are rising globally, posing significant challenges in healthcare system. Besides, studies over the years have proved that patients with inflammatory bowel disease (IBD) have a higher incidence of rCDI and worse outcomes. Compared to antibiotic treatments, Fecal Microbiota Transplantation (FMT) is a more effective treatment for rCDI. Considering the high cost of FMT, there’s a need to investigate the cost-effectiveness in Taiwan to make the best use under limited finance resources.

METHODS: Decision tree analysis was applied to evaluate the cost and effectiveness of different treatments for rCDI patients with a time horizon of 90 days from payer perspective. Willingness-to-pay (WTP) was set as three times GDP per capita. Deterministic and probabilistic sensitivity analyses were performed to understand the uncertainty.

RESULTS: Compared to vancomycin, FMT was cost-effective in overall rCDI patients as well as IBD patients with rCDI [USD101,449.40 (NT$ 2,840,583.33)/quality-adjusted life year (QALY) gained and USD95,020.35 (NT$ 2,660,569.86)/QALY gained] respectively. Compared to fidaxomicin, FMT was not cost-effective [USD123,996.29 (NT$ 3,471,896.36)/ QALY gained] in overall rCDI patients and slightly increased QALY (0.012 QALY gained) in IBD patients with rCDI.

CONCLUSIONS: FMT via colonoscopy appeared to have better QALY gained compared to vancomycin and fidaxomicin in all scenarios, but FMT was only cost-effective compared to vancomycin in rCDI and IBD patients with rCDI patients in Taiwan.