Fidaxomicin in the Treatment of Clostridium difficile-Associated Diarrhoea

Abstract

We read with interest the correspondence by Greig com-paring outlays for fidaxomicin for the treatment of allprimary cases of Clostridium difficile-associated diarrhoea(CDAD), in persons aged [65 years, and for persons inreceipt of concomitant antimicrobial pharmacotherapy,with mean expenditures for hospitalization for CDAD inthe UK [1].We agree with Greig that the fiscal benefits ofemploying fidaxomicin in the treatment of CDAD extendbeyond the acquisition cost of medication, and that thepotential to reduce transmission of disease will afford amore robust financial profile in favour of fidaxomicin.Our research comparing outlays for fidaxomicin versusvancomycin for the treatment of CDAD, with an end-pointof warranted price from the perspective of the US health-care system, concluded fidaxomicin represented value formoney [2]. To examine this issue, we employed the num-ber-needed-to-treat (NNT) as derived from the registrationstudies with the US Food and Drug Administration(NNT = 7.1). Moreover, to discern the fiscal utility offidaxomicin in both primary and secondary cases ofCDAD, we employed the methodology developed byO’Brien et al. [3] for attribution of hospital outlays due toCDAD in secondary cases. This approach resulted in amore conservative hurdle for fidaxomicin. Finally, itshould be noted that our research employed national (US)data for both primary and secondary cases of CDAD [4].Greig is correct to note that there are limited compara-tive data as regards the use of vancomycin versus metro-nidazole in the treatment of CDAD. That said, from apolicy perspective, results reported by Greig [1] and Sclaret al. [2] indicate that fidaxomicin represents a judiciousfiscal choice among select populations hospitalized forCDAD.References