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 <euro> 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 <euro> 1,572 per component, corresponding to a total cost of FMT treatment (two components) of <euro> 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 <euro> 3,144. (c) 2024 The Author(s). Published by Elsevier Ltd on behalf of The Healthcare Infection Society. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).