New data presented at the 54th Interscience Conference on Antimicrobial Agents and Chemotherapy (ICAAC 2014) show that overall treatment costs for cancer patients with clostridium difficile infection (CDI), based on a decision tree analysis, are lower with fidaxomicin compared to current standard of care, vancomycin, resulting in a potential cost saving of €5,600 per patient.2 Patients who have received chemotherapy and those with solid tumours can be particularly susceptible to CDI due to their long hospital stays and exposure to many antibiotics and chemotherapeutic agents.3 These patients are also prone to recurrent episodes of CDI.4

This pharmacoeconomic model combined data from a study exploring the resolution of CDI in cancer patients treated with either fidaxomicin or vancomcyin2,4 and a recent cost-of-illness analysis on CDI conducted at the University Hospital of Cologne.2,5 The analysis explored direct cost parameters including drug costs, treatment on the general ward and intensive care unit as well as microbiological diagnostics for clostridium difficile.2 Mean overall treatment costs per patient treated with fidaxomicin and vancomycin were €22,200 vs €27,800.2 The lower costs associated with fidaxomicin are primarily due to the significantly lower rate of recurrence in patients treated with fidaxomicin compared to vancomycin.2,4

"Patients with cancer represent a vulnerable population who are at high risk of CDI, often resulting from their compromised immune system. CDI can be a devastating addition for patients who are already battling pre-existing conditions. We have already seen the superior reductions in CDI recurrence with fidaxomicin so we are pleased to see it also clearly demonstrating cost effectiveness" said Sebastian Heimann, health economist at the University Hospital of Cologne, Germany and lead investigator of the study.

The cost effectiveness of fidaxomicin has also been clearly demonstrated in a first of its kind study conducted recently at St George's Hospital in London.6 The study looked at a year's experience using fidaxomicin as a first-line treatment for all adults confirmed to have CDI, including populations not previously studied in randomised controlled Phase III trials.6,7 Treatment with fidaxomicin led to a reduction in recurrence for patients with CDI and a saving of over £48,000 in the financial year to the UK's NHS versus standard of care treatment (vancomycin or metronidazole).8

In other data presented at ICAAC, physician perceptions of the burden of CDI and the negative health impact of recurrent infection were assessed.9 Nearly all of the 1,567 healthcare professionals surveyed accept that a recurrence of CDI would have a medium or strong impact on patient health in particular immunocompromised patients and those with a severe underlying disease.9 Despite this, the majority (60%) do not very often consider this impact in their treatment decisions.9

Additionally, only 26% of respondents in this survey always request a laboratory test for patients presenting with unexplained diarrhoea that is not clearly attributable to an underlying condition or therapy,9 despite recent epidemiological data suggesting the incidence of CDI is increasing in Europe.10 Interestingly, physicians believed 25% of clinically-significant CDI cases remain undiagnosed in a hospital setting increasing to as much as 45% in the community.9 This is supported by a recent epidemiologic study which revealed that as many as 39,000 cases of CDI may be missed each year in Europe.10

"There is a growing body of evidence that supports the increasing prevalence of CDI in Europe yet there is still a significant lack of clinical suspicion and standardisation of laboratory testing, meaning cases may be being missed" comments Professor Oliver Cornely, University Hospital Cologne, Germany. "CDI is a huge economic and societal burden and causes additional and unnecessary suffering to already sick patients so there is clearly more that needs to be done to improve patient care and CDI management."

CDI is one of the most common causes of antibiotic-associated diarrhoea and severe cases can lead to bowel surgery and even death.11 Hospital patients with CDI are up to three times more likely to die in hospital (or within a month of infection) than those without CDI.12,13 Recurrence is a major challenge in CDI treatment, 25% of CDI patients suffer a recurrence within one month 14,15,16 and patients who have already had one recurrence have a 40% risk of a further episode of CDI.17