OBJECTIVES: Clostridioides difficile infection (CDI) is the most frequently reported hospital-acquired pathogen which causes diarrhea and colitis. Almost half a million CDI cases are reported annually in the US. Recent guidelines recommend use of fidaxomicin or vancomycin as the initial therapy for CDI. The current analysis aimed to estimate the budget impact of the use of fidaxomicin vs vancomycin from a hospital perspective in the US.

METHODS: A decision analytic model was developed, considering treatment of the initial CDI episode and one CDI recurrence over a one-year period, in patients who had no prior CDI episode. Two scenarios were compared, one with only vancomycin, and one with a mix of fidaxomicin (15%) and vancomycin (85%). The analysis included costs and payments of medications and the cost of managing recurrent CDI, as well as proportion of days of therapy across management settings (inpatient 20%, outpatient 80%). Parameters were retrieved from published sources; where not available, experts’ opinion was sought. The budget impact was calculated as the difference in revenue (difference in payments and costs) between scenarios. One-way sensitivity analyses were performed on key parameters. Costs were expressed in 2019 US dollars.

RESULTS: Among 10,000 hypothetical hospitalizations, treatment with fidaxomicin in 15% of patients with no prior CDI episode instead of vancomycin was expected to result in a potential savings of $12,153 at the hospital level, $150 per treated CDI patient, and $1.22 per admitted patient. The additional cost of fidaxomicin (vs vancomycin) was offset by its lower CDI recurrence rate. Sensitivity analyses demonstrated the robustness of results.

CONCLUSIONS: Although the cost of fidaxomicin is higher than vancomycin, savings can be achieved with fidaxomicin due to its superior sustained clinical response. Broader benefits of fidaxomicin should be considered by healthcare stakeholders and policy makers when making decisions about formulary inclusion and adoption.