Published online Nov 16, 2015. doi: 10.12998/wjcc.v3.i11.935
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.
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.