A retrospective budget impact analysis of fidaxomicin treatment for Clostridioides difficile infections (CDI) in Germany

ABSTRACT

Background

Clostridioides difficile is the most common cause of healthcare-associated diarrhea. Research suggests that treating C. difficile infections (CDI) with fidaxomicin (FDX) is more effective than vancomycin (VAN), with potential cost savings. The objective was to calculate the budget impact of FDX treatment compared to VAN from a German payer perspective.

Research design and methods

The analysis used real-world data of patients discharged from University Hospital Cologne between Jan-01–2018 and Dec-31–2019. We identified recurrent and non-recurrent CDI cases and calculated direct treatment costs based on G-DRG flat rates. To calculate average costs per treatment and the budget impact, recurrence probabilities for VAN and FDX were taken from published evidence (28-day and 90-day scenarios).

Results

Totally, 475 cases were analyzed, thereof 421 non-recurrent, causing mean costs of €32,901 per case (95% CI: 27.752–38.050). Thirty-two patients experienced a recurrence within 28 days, yielding mean costs of €10,952 (95% CI: 5.627–16.277) for their additional hospital stay. The resulting budget impact was €1,303 (95% CI: 670–1.937) in favor of FDX, ranging from €148.34 to €2,190.30 in scenario analyses.

Conclusion

The analysis indicates FDX treatment can lead to cost savings compared to VAN. Future research should focus on specific patient groups, such as refractory CDI patients.

KEYWORDS:

• Budget impact analysis
• fidaxomicin
• recurrent Clostridioides difficile infection
• vancomycin
• health economics
• Clostridioides difficile

Declaration of interest

AC Siefen, MS Kurte, AM Bauer, S Wingen-Heimann, and F Kron are employees of VITIS Healthcare Group, which was sponsored by TILLOTTS PHARMA AG in connection with the development of this manuscript. S Wingen-Heimann has received research and travel grants from Astellas, Merck, and Tillotts; research grants from Basilea, Gilead, and 3 M; travel grants from Pfizer; lecture honoraria from Astellas, Merck, and Tillotts; and is a consultant to Basilea, Gilead, and Merck. OA Cornely reports grants or contracts from Basilea, Cidara, F2G, Gilead, MedPace, MSD, Mundipharma, Octapharma, Pfizer, Scynexis; Consulting fees from AbbVie, Biocon, Biosys, Cidara, Gilead, IQVIA, Janssen, MedPace, Menarini, Molecular Partners, Noxxon, Octapharma, Pfizer, PSI, Scynexis, Seres; Honoraria for lectures from Abbott, AbbVie, Al-Jazeera Pharmaceuticals, Astellas, Gilead, Grupo Biotoscana/United Medical/Knight, Hikma, MedScape, Merck/MSD, Mylan, Noscendo, Pfizer, Shionogi; Payment for expert testimony from Cidara; Participation on a Data Safety Monitoring Board or Advisory Board from Cidara, Entasis, IQVIA, Janssen, MedPace, Paratek, PSI, Pulmocide, Shionogi, The Prime Meridian Group. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer disclosures

A reviewer on this manuscript has disclosed they have given paid lectures for Tillot’s UK and previously received a grant from Astellas. Peer reviewers on this manuscript have no other relevant financial relationships or otherwise to disclose.

Authors’ contributions

All authors contributed to the study’s conception and design. Material preparation, data collection, and statistical analysis were performed by AC Siefen, MS Kurte, AM Bauer, S Wingen-Heimann. All authors were involved in writing the manuscript and approved the final version.

Data availability statement

All data generated or analyzed during this study are included in this published article.

Additional information

Funding

This study was funded by TILLOTTS PHARMA AG. The funder of the study had no role in study design, data collection, data analysis, data interpretation, and writing of the manuscript.