Cost-effectiveness of faecal microbiota transplantation compared with vancomycin monotherapy for early Clostridioides difficile infection: economic evaluation alongside a randomized controlled trial

Background

For Clostridioides difficile infection (CDI), faecal microbiota transplantation (FMT) is currently recommended for patients with three or more CDI episodes. A recent randomised controlled trial (RCT) show that FMT may be considered early, defined as intervention during the first or second CDI episode.

Aim

The aim was to investigate hospital costs of FMT as a complementary treatment compared with current standard care in patients with first or second CDI.

Findings

Compared with standard care for first or second CDI, patients randomised to FMT had €1,645 lower hospital costs over 26 weeks owing to fewer admissions and hospital contacts and less medication use. In the sensitivity analyses, FMT remained cost-effective as long as the treatment cost of FMT stayed below approximately €1,572 per component, corresponding to a total cost of FMT treatment (two components) of €3,144.

Conclusion

FMT was cost-effective with both lower costs and greater effectiveness than current standard care involving vancomycin monotherapy. The findings were robust to sensivity analyses, with a threshold cost for one FMT treatment consisting of two components of €3,144.