Economic evaluation of Faecal Microbiota Transplantation compared to antibiotics for the treatment of recurrent Clostridioides difficile infection

Research output: Contribution to journalArticle

Colleges, School and Institutes


Background: Clostridioides difficile infection (CDI) is a hospital acquired disease associated with significant morbidity, hospitalisation and mortality. Almost 30% of treated patients experience at least one recurrence after treatment of their first episode. Treatment of recurrent CDI (rCDI) utilises vancomycin or fidaxomicin, however, a newer treatment option is faecal microbial transplantation (FMT) administered by nasogastric tube (NGT) or colonoscopy. It is associated with higher cure and lower recurrence rates than fidaxomicin or vancomycin. The aim of this analysis is to evaluate the cost effectiveness of FMT for rCDI using the latest and best evidence.

Method: A cost utility analysis was conducted using a decision model representing the cost per additional Quality Adjusted Life Year (QALY) from a National Health Service (NHS) perspective. A Markov model was constructed to compare FMT NGT and colonoscopy to antibiotic treatment (fidaxomicin or vancomycin). The model was informed by a literature review of clinical evidence, specifically focussing on hospitalised patients with rCDI over 65 years. Both deterministic and probabilistic sensitivity analyses were performed to assess uncertainties around the model inputs and assumptions.

Findings: The base case analysis showed that FMT is a less costly and more effective treatment than either fidaxomicin or vancomycin. FMT colonoscopy was slightly more effective than FMT NGT leading to an additional 0.02 QALYs but more expensive and the incremental cost effective ratio (ICER) was £193,050/QALY. The Probabilistic sensitivity analysis based on 10,000 simulations suggested the probability of FMT NGT being cost effective was almost 78% at £20,000/QALY Willingness–To-Pay (WTP) threshold.

Interpretation: FMT is both more effective and less costly option than antimicrobial therapy. FMT NGT was the preferred route of administration and is likely to be considered the most cost-effective strategy by decision makers given current acceptable thresholds.

Funding: None


Original languageEnglish
Article number100420
Number of pages8
Early online date27 Jun 2020
Publication statusPublished - Jul 2020


  • Clostridioides difficile infection (previously as Clostridium difficile Infection), Recurrence, Economic evaluation, cost-effectiveness analysis, cost utility analysis, faecal microbiota transplantation, fidaxomicin, vancomycin