Cost-effectiveness of Fecal Microbiota Transplantation for First Recurrent Clostridioides difficile Infection
Open accessAbstract
BACKGROUND: Both the American College of Gastroenterology and the Infectious Diseases Society of America (IDSA)/Society for Healthcare Epidemiology of America 2021 Clostridioides difficile infection (CDI) guidelines recommend fecal microbiota transplantation (FMT) for persons with multiple recurrent CDI. Emerging data suggest that FMT may have high cure rates when used for first recurrent CDI. The aim of this study was to assess the cost-effectiveness of FMT for first recurrent CDI. METHODS: We developed a Markov model to simulate a cohort of patients presenting with initial CDI infection. The model estimated the costs, effectiveness, and cost-effectiveness of different CDI treatment regimens recommended in the 2021 IDSA guidelines, with the additional option of FMT for first recurrent CDI. The model includes stratification by the severity of initial infection, estimates of cure, recurrence, and mortality. Data sources were taken from IDSA guidelines and published literature on treatment outcomes. Outcome measures were quality-adjusted life-years (QALYs), costs, and incremental cost-effectiveness ratios (ICERs). RESULTS: When FMT is available for first recurrent CDI, the optimal cost-effective treatment strategy is fidaxomicin for initial nonsevere CDI, vancomycin for initial severe CDI, and FMT for first and subsequent recurrent CDI, with an ICER of $27 135/QALY. In probabilistic sensitivity analysis at a $100 000 cost-effectiveness threshold, FMT for first and subsequent CDI recurrence was cost-effective 90% of the time given parameter uncertainty. CONCLUSIONS: FMT is a cost-effective strategy for first recurrent CDI. Prospective evaluation of FMT for first recurrent CDI is warranted to determine the efficacy and risk of recurrence.
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FMT has been shown to be a cost-effective strategy for rCDI.
“Additionally, FMT has been shown to be a costeffective strategy for this disorder. 7”
From Key determinants of success in fecal microbiota transplantation: From microbiome to clinic (2023) · cites this paper as [7]
FMT has proven to be a reliable therapeutic alternative to the antibiotics vancomycin and fidaxomicin for rCDI.
“has proven to be a reliable therapeutic alternative to the antibiotics vancomycin 6,7 and fidaxomicin. 8”
From Key determinants of success in fecal microbiota transplantation: From microbiome to clinic (2023) · cites this paper as [7]
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Li, M., 宗海鹰, Yang, X., Liu, Q., Wang, J., Wang, M., Wu, D., Zheng, S., Wang, H., & Long, Q. (2026) · Acta Biochimica et Biophysica Sinica · doi:10.3724/abbs.2026007
Kahook, Z., Alamgir, M., Mohan, V., Ramasamy, A. B., Sumartono, A. H. I., Manucharyan, A., Adhikari, P., Jeripeti, S., Mohanarajan, M., Sherry, A., et al. (2026) · The Egyptian Journal of Internal Medicine · doi:10.1186/s43162-026-00673-4
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Fecal Microbiota Transplantation
Haag, L.-M., Nowak, F., & Siegmund, B. (2026) · Springer eBooks · doi:10.1007/978-3-032-26410-7_20
Novel options for the management of C. difficile : a look into the future
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- Authors
- Aby, E. S., Vaughn, B. P., Enns, E. A., & Rajasingham, R.
- Affiliations
- University of Minnesota (US)
- Corresponding author
- Vaughn, Byron P
- Rajasingham, Radha
- Venue
- Clinical Infectious Diseases
- Publisher
- Oxford University Press (OUP)
- Published
- 2022-03-11
- Volume
- 75
- Issue
- 9
- Pages
- 1602-1609
- ISSN
- 1058-4838 (ISSN-L)
- 1537-6591
- PMC
- PMC9617579
- OpenAlex
- W4220946700
- Cited by
- 28
- References
- 60
- Citations by year
- 2026: 10 · 2025: 4 · 2024: 7 · 2023: 6 · 2022: 1
- FWCI
- 2.20
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Clinical Infectious Diseases (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institute of Allergy and Infectious Diseases (K23AI13885, K25AI118476)
- Topics
- Health Sciences › Medicine › Infectious Diseases › Clostridium difficile and Clostridium perfringens research
- Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Health Systems, Economic Evaluations, Quality of Life
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Biology › Gut microbiota and health
- Keywords
- fecal microbiota transplantation, recurrent Clostridium difficile infection, cost-effectiveness, fidaxomicin, vancomycin, Markov model, quality-adjusted life years, incremental cost-effectiveness ratio, infection severity, treatment strategy comparison
- MeSH terms
- Fecal Microbiota Transplantation, Anti-Bacterial Agents, Clostridium Infections, Cost-Benefit Analysis, Humans, Recurrence, Clostridioides difficile, Treatment Outcome
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