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Open Forum Infect Dis. 2017 Jul 22;4(3):ofx148. doi: 10.1093/ofid/ofx148. eCollection 2017 Summer.

Cost-Effectiveness Analysis of Probiotic Use to Prevent Clostridium difficile Infection in Hospitalized Adults Receiving Antibiotics.

Author information

1
Division of Gastroenterology and Hepatology, Department of Medicine.
2
Department of Healthcare Policy and Research, and.
3
Hospitalist Medicine Section, Division of General Internal Medicine, Department of Medicine, University of Colorado, Denver.
4
Division of Gastroenterology, Department of Medicine, New York University, New York.
5
Division of Infectious Diseases, Department of Medicine, Weill Cornell Medical College, New York, New York.

Abstract

Background:

Systematic reviews with meta-analyses and meta-regression suggest that timely probiotic use can prevent Clostridium difficile infection (CDI) in hospitalized adults receiving antibiotics, but the cost effectiveness is unknown. We sought to evaluate the cost effectiveness of probiotic use for prevention of CDI versus no probiotic use in the United States.

Methods:

We programmed a decision analytic model using published literature and national databases with a 1-year time horizon. The base case was modeled as a hypothetical cohort of hospitalized adults (mean age 68) receiving antibiotics with and without concurrent probiotic administration. Projected outcomes included quality-adjusted life-years (QALYs), costs (2013 US dollars), incremental cost-effectiveness ratios (ICERs; $/QALY), and cost per infection avoided. One-way, two-way, and probabilistic sensitivity analyses were conducted, and scenarios of different age cohorts were considered. The ICERs less than $100000 per QALY were considered cost effective.

Results:

Probiotic use dominated (more effective and less costly) no probiotic use. Results were sensitive to probiotic efficacy (relative risk <0.73), the baseline risk of CDI (>1.6%), the risk of probiotic-associated bactermia/fungemia (<0.26%), probiotic cost (<$130), and age (>65). In probabilistic sensitivity analysis, at a willingness-to-pay threshold of $100000/QALY, probiotics were the optimal strategy in 69.4% of simulations.

Conclusions:

Our findings suggest that probiotic use may be a cost-effective strategy to prevent CDI in hospitalized adults receiving antibiotics age 65 or older or when the baseline risk of CDI exceeds 1.6%.

KEYWORDS:

Clostridium difficile; antibiotic-associated diarrhea; cost-effectiveness; prevention; probiotic

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