Evidence-Based Medicine
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Nov 16, 2015; 3(11): 935-941
Published online Nov 16, 2015. doi: 10.12998/wjcc.v3.i11.935
Cost-effectiveness in Clostridium difficile treatment decision-making
Mark JC Nuijten, Josbert J Keller, Caroline E Visser, Ken Redekop, Eric Claassen, Peter Speelman, Marja H Pronk
Mark JC Nuijten, Ars Accessus Medica, 1546 LG Jisp, The Netherlands
Josbert J Keller, HAGA Teaching Hospital, 2545 CH Den Haag, The Netherlands
Caroline E Visser, Clinical Microbiologist AMC, 1105 AZ Amsterdam, The Netherlands
Ken Redekop, iMTA and BMG EUR, 3062 PA Rotterdam, The Netherlands
Eric Claassen, EUR, Rotterdam, 3062 PA Rotterdam, The Netherlands
Peter Speelman, AMC, 1105 AZ Amsterdam, The Netherlands
Marja H Pronk, Europe-ExPro, 81669 Munich, Germany
Author contributions: Nuijten MJC and Pronk MH designed research; Nuijten MJC and Pronk MH performed research; Keller JJ, Visser CE, Redekop K, Claassen E and Speelman P contributed for analytic tools; Nuijten MJC and Pronk MH analyzed data; Nuijten MJC, Keller JJ, Visser CE, Redekop K, Claassen E, Speelman P and Pronk MH wrote the paper.
Conflict-of-interest statement: The authors declare no conflicts of interest.
Data sharing statement: None.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Mark JC Nuijten, PhD, MD, MBA, Ars Accessus Medica, Dorpsstraat 75, 1546 LG Jisp, The Netherlands. marknuijten@planet.nl
Telephone: +31-620-427827 Fax: +31-756-422456
Received: August 26, 2014
Peer-review started: August 26, 2014
First decision: September 28, 2014
Revised: July 28, 2015
Accepted: August 4, 2015
Article in press: August 7, 2015
Published online: November 16, 2015

AIM: To develop a framework for the clinical and health economic assessment for management of Clostridium difficile infection (CDI).

METHODS: CDI has vast economic consequences emphasizing the need for innovative and cost effective solutions, which were aim of this study. A guidance model was developed for coverage decisions and guideline development in CDI. The model included pharmacotherapy with oral metronidazole or oral vancomycin, which is the mainstay for pharmacological treatment of CDI and is recommended by most treatment guidelines.

RESULTS: A design for a patient-based cost-effectiveness model was developed, which can be used to estimate the cost-effectiveness of current and future treatment strategies in CDI. Patient-based outcomes were extrapolated to the population by including factors like, e.g., person-to-person transmission, isolation precautions and closing and cleaning wards of hospitals.

CONCLUSION: The proposed framework for a population-based CDI model may be used for clinical and health economic assessments of CDI guidelines and coverage decisions for emerging treatments for CDI.

Keywords: Clostridium difficile infection, Guidance, Cost-effectiveness, Model, Standardisation, Decision making

Core tip: Current clinical guidelines seldom include cost-effectiveness evaluations. Conclusions are typically based on clinical data only and sometimes referral is made to prices of therapies for justification of the treatment sequence advised. However, the price of a therapy as such is just a single criterion and does not reflect the balance between effectiveness and costs associated with the application of that therapy. This results often in a restricted position of new therapies in the treatment algorithm. Integration of cost-effectiveness using the population-based variant of cost-effectiveness evaluations as an instrument in guidelines for Clostridium difficile infection may be provide better decision making framework.