Fecal microbiota treatment (FMT) can be a cost-effective option to antibiotics for treating patients with clostridiodes difficile infections (CDI) and inflammatory bowel disease (IBD).

A team, led by Kai-Yen Lan, Department of Biomedical Sciences, Chang Gung University, compared the costs of FMT with vancomycin and fidaxomicin in recurrent CDI patients with and without IBD.

FMT

Patients with IBD are at a higher risk of incidence CDI and generally worse outcomes compared to non-IBD patients. While antibiotics can be effective, FMT has shown promise in the treatment for refractory or recurrent CDI.

Fecal microbiota transplantation is a relatively new treatment that involves taking feces from healthy donors to rebuild the gut microbiota of a diseased individual. FMT is delivered through upper or lower endoscopy via enemas or capsules.

In recent years, FMT has become a top treatment for recurrent CDI, with cure rates of 82-88%. In fact, FMT has shown more efficacy than the antibiotics commonly used to treat the infections and has spurred a new class of treatments called live microbiota therapeutics.

Evidence suggests human metabolic profiles could be influenced by the treatment.

However, investigators have yet to evaluate the cost-effectiveness of FMT for the treatment of recurrent CDI, particularly patients with IBD and recurrent CDI.

Evaluating the Cost

In the comparative study, the investigators evaluated the cost and effectiveness of different treatments using a Markov model with deterministic and probalistic sensitivity analyses

The team compared the cost and clinical outcomes of FMT through colonoscopy to vancomycin and fidaxomicin, common antibiotics used to treat CDI, using data from Chang Gung Memorial Hospital, Linkou Branch in Taiwan.

The results show FMT was cost-effective compared to vancomycin in both the general CDI population, as well as the subset of patients with IBD (NT$1,101,971.98/ quality-adjusted life year (QALY) gained in overall patients; NT$1,833,719.14/QALY gained in IBD patients).

However, the results were different when compared to fidaxomicin. Here, FMT was only cost-effective in overall in patients with rCDI (NT$567,133.45/QALY gained) but only slightly increased in QALY in the IBD subset (0.0018 QALY gained).

“FMT is cost-effective, compared to vancomycin or fidaxomicin for treatment of rCDI in most scenarios from payer's perspective in Taiwan,” the authors wrote. “These findings can help health authorities to create reimbursement policy for FMT in rCDI.”

FMT and IBD

During the 2022 American College of Gastroenterology Meeting in Charlotte, investigators from Michigan State University found initial research supports the use of FMT as a treatment for IBD.

In the study, the investigators reviewed multiple databases for randomized controlled trials concerning patients with active IBD treated with FMT compared to placebo.

In the efficacy analysis, clinical (OR, 1.506; 95% CI, 1.259-1.803), P <0.0001), endoscopic (OR, 2.335; 95% CI, 1.577-3.457, P <0.0001), and histologic (OR, 3.764; 95% CI, 1.986-7.136; P <0.001) remission were consistent with previous results.

References:

Lan, Kai-Yen and Le, Puo-Hsien and Chiu, Cheng-Tang and Chen, Chien-Chang and Yeh, Yuan-Ming and Cheng, Hao-Tsai and Kuo, Chia-Jung and Chen, Chyi-Liang and Chen, Yi-Ching and Yeh, Pai-Jui and Chiu, Cheng-Hsun and Chang, Chee-Jen, Cost-Effectiveness Analysis of Fecal Microbiota Transplantation for Treatment of Refractory or Recurrent Clostridioides Difficile Infection in Taiwan. Available at SSRN: https://ssrn.com/abstract=4356859 or http://dx.doi.org/10.2139/ssrn.4356859