Whitney Laura, Nesnas John, Planche Timothy
St George's University Hospitals NHS Foundation Trust, London SW17 0QT, UK.
Infection Care Group, St George's University Hospitals NHS Foundation Trust, London SW17 0QT, UK.
Antibiotics (Basel). 2023 Jan 6;12(1):106. doi: 10.3390/antibiotics12010106.
Fidaxomicin, a macrocyclic antibiotic, selectively kills Clostridioides difficile and reduces C. difficile infection (CDI) recurrence compared with vancomycin, but some studies and guidelines report fidaxomicin as being less cost-effective. The aim of this study was to compare the cost-effectiveness and budget impact of fidaxomicin versus vancomycin or metronidazole for treating CDI in a real-world UK setting. Data were retrospectively collected from medical records of 86 patients with CDI treated with vancomycin or metronidazole at a single UK hospital between April 2011 and March 2012, and prospectively from 62 patients with CDI treated with fidaxomicin between August 2012 and July 2013. CDI cases were matched by age, financial year, and healthcare resource use to control cases. CDI recurrence rates were lower with fidaxomicin (6.5%) than vancomycin/metronidazole (19.8%). An estimated 12 additional recurrent CDIs were prevented with fidaxomicin treatment. Patients with CDI had significantly higher healthcare costs than those without CDI, with a mean excess spend of GBP 10,748 and GBP 17,451 per patient in the fidaxomicin (p = 0.015) and vancomycin/metronidazole cohorts (p < 0.001), respectively. A second CDI was associated with mean excess costs of GBP 8373 and GBP 20,249 per patient in the fidaxomicin and vancomycin/metronidazole cohorts, respectively. Despite higher fidaxomicin drug costs, overall cost savings were estimated at GBP 140,292 (GBP 2125 per CDI). In this real-world study, first-line CDI treatment with fidaxomicin reduced healthcare costs versus vancomycin/metronidazole, consistent with previous studies.
非达霉素是一种大环内酯类抗生素，与万古霉素相比，它能选择性地杀死艰难梭菌并降低艰难梭菌感染（CDI）的复发率，但一些研究和指南报告称非达霉素的成本效益较低。本研究的目的是在英国的实际环境中比较非达霉素与万古霉素或甲硝唑治疗CDI的成本效益和预算影响。数据回顾性收集自2011年4月至2012年3月在英国一家医院接受万古霉素或甲硝唑治疗的86例CDI患者的病历，并前瞻性收集自2012年8月至2013年7月接受非达霉素治疗的62例CDI患者的病历。CDI病例按年龄、财政年度和医疗资源使用情况与对照病例进行匹配。非达霉素治疗的CDI复发率（6.5%）低于万古霉素/甲硝唑治疗组（19.8%）。非达霉素治疗估计可预防12例额外的CDI复发。CDI患者的医疗费用显著高于非CDI患者，非达霉素组和万古霉素/甲硝唑组每位患者的平均额外支出分别为10748英镑和17451英镑（p = 0.015）和（p < 0.001）。第二次CDI分别与非达霉素组和万古霉素/甲硝唑组每位患者8373英镑和20249英镑的平均额外成本相关。尽管非达霉素的药物成本较高，但总体成本节省估计为140292英镑（每例CDI节省2125英镑）。在这项实际研究中，与万古霉素/甲硝唑相比，非达霉素一线治疗CDI可降低医疗成本，这与之前的研究一致。
