Fidaxomicin to prevent recurrent Clostridioides difficile : what will it cost in the USA and Canada?

Autor:	Patel D; Faculty of Medicine and Health Sciences, McGill University, Montréal, Canada., Senecal J; Faculty of Medicine and Health Sciences, McGill University, Montréal, Canada., Spellberg B; Los Angeles County and University of Southern California Medical Center, Los Angeles, CA, USA., Morris AM; Division of Infectious Diseases, Department of Medicine, Sinai Health, University Health Network, and University of Toronto, Toronto, Canada., Saxinger L; Division of Infectious Diseases, Department of Medicine, University of Alberta, Edmonton, Canada., Footer BW; Providence Portland Medical Center, Portland, USA., McDonald EG; Division of General Internal Medicine, Department of Medicine, McGill University Health Centre, Montréal, Canada.; Clinical Practice Assessment Unit, Department of Medicine, McGill University Health Centre, Montréal, Canada., Lee TC; Division of General Internal Medicine, Department of Medicine, McGill University Health Centre, Montréal, Canada.; Clinical Practice Assessment Unit, Department of Medicine, McGill University Health Centre, Montréal, Canada.; Division of Infectious Diseases, Department of Medicine, McGill University Health Centre, Montréal, Canada.
Jazyk:	angličtina
Zdroj:	JAC-antimicrobial resistance [JAC Antimicrob Resist] 2023 Jan 07; Vol. 5 (1), pp. dlac138. Date of Electronic Publication: 2023 Jan 07 (Print Publication: 2023).
DOI:	10.1093/jacamr/dlac138
Abstrakt:	Importance: Recent changes in guidelines for managing Clostridioides difficile infections (CDI) have placed fidaxomicin as a first-line treatment. Objective: To estimate the net cost of first-line fidaxomicin compared to vancomycin in the American and Canadian healthcare systems and to estimate the price points at which fidaxomicin would become cost saving for the prevention of recurrence. Data Sources and Study Selection: We identified randomized, placebo-controlled trials directly comparing fidaxomicin with vancomycin that reported on recurrence. Medication costs were obtained from the Veterans Affairs Federal Supply Schedule (US) and the Quebec drug formulary (Canada). The average cost of a CDI recurrence was established through a systematic review for each country. Data Extraction Synthesis and Outcome Measures: For efficacy, data on CDI recurrence at day 40 were pooled using a restricted maximal likelihood random effects model. For the cost review, the mean cost across identified studies was adjusted to reflect May 2022 dollars. These were used to estimate the net cost per recurrence prevented with fidaxomicin and the price point below which fidaxomicin would be cost saving. Results: The estimated mean system costs of a CDI recurrence were $15 147USD and $8806CAD, respectively. Preventing one recurrence by using first-line fidaxomicin over vancomycin would cost $38 222USD (95%CI $30 577-$57 332) and $13 760CAD (95%CI $11 008-$20 640), respectively. The probability that fidaxomicin was cost saving exceeded 95% if priced below $1140USD or $860CAD, respectively. Conclusions and Relevance: An increased drug expenditure on fidaxomicin may not be offset through recurrence prevention unless the fidaxomicin price is negotiated. (© The Author(s) 2023. Published by Oxford University Press on behalf of British Society for Antimicrobial Chemotherapy.)
Databáze:	MEDLINE
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