Cost savings following faecal microbiota transplantation for recurrent Clostridium difficile infection

Abstract

Background: Recurrent Clostridium difficile infection (rCDI) is becoming increasingly common. Faecal microbiota transplantation (FMT) is effective for rCDI, but the costs of an FMT and hospital cost savings related to FMT are unknown. The aim of this study was to calculate the cost of an FMT and the total hospital costs before and after FMT.

Methods: This was an observational single-centre study, carried out in a public teaching hospital. We included all patients referred for rCDI from January 2014 through December 2015 and documented costs related to donor screening, laboratory processing, and clinical FMT application. We calculated patient-related hospital costs 1 year before FMT (pre-FMT) and 1 year after FMT (post-FMT). Sensitivity analyses were applied to assess the robustness of the results.

Results: We included 50 consecutive adult patients who had a verified diagnosis of rCDI and were referred for FMT. The average cost of an outpatient FMT procedure if donor faeces were applied by colonoscopy was €3,326 per patient and €2,864 if donor faeces were applied using a nasojejunal tube. The total annual pre-FMT hospital costs per patient were €56,415 (95% confidence interval (CI) 41,133-71,697), and these costs dropped by 42% to €32,816 (22,618-42,014) post-FMT (p = 0.004). The main cost driver was hospital admissions. Sensitivity analyses demonstrated cost reductions in all scenarios.

Conclusions: In a public hospital with an implemented FMT service, the average cost of FMT applied by either colonoscopy or nasojejunal tube was €3,095. Total hospital costs dropped by 42% the first year after FMT. The reduction was mainly caused by reductions in the number of hospital admissions and in length of stay.

Keywords: Clostridium difficile infection; faecal microbiota transplantation; health economics.

Figure 1.

Clinical application framework for faecal microbiota transplantation (FMT), including donor recruitment and screening, laboratory processing and clinical application (adapted from Jørgensen et al.).

Figure 2.

Study design with calculation of total hospital-related costs 1 year before the first faecal microbiota transplantation (FMT) (pre-FMT) and 1 year after the first FMT (post-FMT). Cost drivers included hospital admission days, intensive care unit admission days, antibiotics use, outpatient visits, telephone consultations, and costs related to the FMT procedure. All costs related to FMT procedures were included in the post-FMT year.

Figure 3.

Comparison of costs 1 year before (pre-FMT) and 1 year after (post-FMT) faecal microbiota transplantation (FMT) for recurrent Clostridium difficile infection (rCDI), in total (A) and subdivided into hospital cost of hospital admission (B), intensive care unit (C), outpatient visits (D), and antibiotics (E). Costs are displayed in euros as the mean per patient with 95% confidence intervals (CI) as error bars.

Figure 4.

The number of admissions and the length of each admission dropped from the year before (left) to the year after (right) faecal microbiota transplantation (FMT) for recurrent Clostridium difficile infection (rCDI).