Extended-pulsed fidaxomicin versus vancomycin for Clostridium difficile infection in patients aged >= 60 years (EXTEND): analysis of cost-effectiveness

被引:22
作者
Cornely, Oliver A. [1 ]
Watt, Maureen [2 ,6 ]
McCrea, Charles [3 ]
Goldenberg, Simon D. [4 ,5 ]
De Nigris, Enrico [2 ]
机构
[1] Univ Cologne, Cologne Excellence Cluster Cellular Stress Respon, ZKS Koln, Clin Trials Ctr Cologne,Dept Internal Med 1, D-50924 Cologne, Germany
[2] Astellas Pharma Inc, Chertsey, England
[3] PAREXEL Access Consulting, London, England
[4] St Thomas Hosp, Kings Coll London, Ctr Clin Infect & Diagnost Res, London, England
[5] St Thomas Hosp, Guys & St Thomas NHS Fdn Trust, London, England
[6] Shire Pharmaceut, CH-6300 Zug, Switzerland
关键词
LENGTH-OF-STAY; MORTALITY; OLDER;
D O I
10.1093/jac/dky184
中图分类号
R51 [传染病];
学科分类号
100401 ;
摘要
Objectives: The randomized Phase IIIb/IV EXTEND trial showed that extended-pulsed fidaxomicin significantly improved sustained clinical cure and reduced recurrence versus vancomycin in patients >= 60 years old with Clostridium difficile infection (CDI). Cost-effectiveness of extended-pulsed fidaxomicin versus vancomycin as first-line therapy for CDI was evaluated in this patient population. Methods: Clinical results from EXTEND and inputs from published sources were used in a semi-Markov treatment-sequence model with nine health states and a 1 year time horizon to assess costs and QALYs. The model was based on a healthcare system perspective (NHS and Personal Social Services) in England. Sensitivity analyses were performed. Results: Patients receiving first-line extended-pulsed fidaxomicin treatment had a 0.02 QALY gain compared with first-line vancomycin (0.6267 versus 0.6038 QALYs/patient). While total drug acquisition costs were higher for extended-pulsed fidaxomicin than for vancomycin when used first-line (1356 pound versus 260 pound/patient), these were offset by lower total hospitalization costs (which also included treatment monitoring and community care costs; 10 pound 815 versus 11459 pound/patient) and lower costs of managing adverse events (694 pound versus 1199 pound/patient), reflecting the lower incidence of CDI recurrence and adverse events with extended-pulsed fidaxomicin. Extended-pulsed fidaxomicin cost 53 pound less per patient than vancomycin over 1 year. The probability that first-line extended-pulsed fidaxomicin was cost-effective at a willingness-to-pay threshold of 30 pound 000/QALY was 76% in these patients. Conclusions: While fidaxomicin acquisition costs are higher than those of vancomycin, the observed reduced recurrence rate with extended-pulsed fidaxomicin makes it a more effective and less costly treatment strategy than vancomycin for first-line treatment of CDI in older patients.
引用
收藏
页码:2529 / 2539
页数:11
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