Methods: Decision-analytic models were constructed to assess the cost-effectiveness of initial CDI management with compounded oral vancomycin compared to oral metronidazole. Models of possible outcomes were based on current treatment guidelines and parameter estimates from published literature. Analyses were stratified by availability of fecal microbiota transplant (FMT) for treatment of recurrent disease and utilized direct costs from a healthcare-system perspective. One-way sensitivity analyses were conducted to determine thresholds for treatment dominance.
Results: Vancomycin was both more effective and less costly, and is therefore considered dominant over metronidazole. When FMT was available (unavailable), the probability of cure was 94.8% (94.2%) with vancomycin and 92.3% (92.1%) with metronidazole. The average total cost of treatment per case was $1781.75 ($1859.72) with vancomycin and $2718.02 ($2741.20) with metronidazole. Treatment with metronidazole was associated with a higher probability of recurrence (16.8% vs 13.6%) and readmission (5.7% vs 1.7%) compared to vancomycin. Per the sensitivity analyses, vancomycin remained dominant across all possible values for the majority of parameters.
Conclusion: Using recent data, we found vancomycin to be more cost-effective than metronidazole for the treatment of initial episodes of mild-moderate CDI in adult inpatients. Reevaluation of current recommendations regarding initial treatment selection may be warranted.
D. Ince, None
E. Ernst, None
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