Table 1.
Transition Probabilities, Costs, and Utilities
| Variable | Base Case | Range | Distribution | References |
|---|---|---|---|---|
| Probabilities | ||||
| Oral metronidazole–cure | 0.710 | 0.500–0.950 | Beta (0.710; SD 0.113) | [14, 16] |
| Oral metronidazole–recurrence | 0.421 | 0.316–0.526 | Beta (0.421; SD 0.053) | [14, 16] |
| Outpatient oral vancomycin–cure | 0.916 | 0.687–1.000 | Beta (0.916; SD 0.115) | [16, 17] |
| Outpatient oral vancomycin–recurrence | 0.355 | 0.323–0.462 | Beta (0.355; SD 0.035) | [16, 17] |
| Fidaxomicin–cure | 0.937 | 0.703–1.000 | Beta (0.937; SD 0.117) | [5, 17] |
| Fidaxomicin–recurrence | 0.197 | 0.148–0.246 | Beta (0.197; SD 0.025) | [5, 17] |
| FMT colonoscopy–cure | 0.945 | 0.715–1.000 | Beta (0.945; SD 0.071) | [8–11] |
| FMT colonoscopy–recurrence | 0.091 | 0.054–0.158 | Beta (0.091; SD 0.026) | [10, 19, 20] |
| FMT duodenal infusion–cure | 0.813 | 0.610–1.000 | Beta (0.813; SD 0.098) | [38] |
| FMT duodenal infusion–recurrence | 0.063 | 0.047–0.078 | Beta (0.063; SD 0.008) | [38] |
| FMT enema–cure | 0.815 | 0.760–0.990 | Beta (0.815; SD 0.058) | [37] |
| FMT enema–recurrence | 0.091 | 0.054–0.158 | Beta (0.091; SD 0.026) | [10, 19, 20, 37] |
| Outpatient oral vancomycin pulse/taper–cure | 0.690 | 0.518–0.863 | Beta (0.690; SD 0.086) | [15, 18] |
| Outpatient oral vancomycin pulse/taper–recurrence | 0.274 | 0.206–0.343 | Beta (0.274; SD 0.034) | [5, 15, 18] |
| Severe CDI if treatment failure | 0.180 | 0.135–0.225 | Beta (0.180; SD 0.023) | [13] |
| Colectomy for severe CDI | 0.280 | 0.013–0.880 | Beta (0.280; SD 0.217) | [23–25] |
| Mortality from severe CDI, postcolectomy | 0.413 | 0.340–0.800 | Beta (0.413; SD 0.115) | [6, 25, 26] |
| Mortality from severe CDI, medical treatment | 0.580 | 0.580–0.805 | Beta (0.580; SD 0.056) | [23–26] |
| Costs, 2012 US$ | ||||
| Oral metronidazole 500 mg tid × 10 d | 22 | 17–28 | Gamma (22; SD 3) | [6], CMS |
| Intravenous metronidazole 500 mg tid × 10 d | 32 | 24–40 | Gamma (32; SD 4) | CMS |
| Outpatient oral vancomycin 125 mg qid × 10 d | 680 | 510–850 | Gamma (680; SD 85) | [6], CMS |
| Vancomycin IV compounded for oral at 125 mg qid × 10 d | 250 | 188–313 | Gamma (250; SD 31) | [6], CMS |
| Oral vancomycin 500 mg qid × 4 d prior to FMT | 1088 | 816–1360 | Gamma (1088; SD 136) | [6], CMS |
| Outpatient oral vancomycin pulse/tapera | 850 | 638–1063 | Gamma (850; SD 106) | [6], CMS |
| Fidaxomicin 200 mg bid × 10 d | 2800 | 2300–3300 | Gamma (2800; SD 250) | [6], CMS |
| Colonoscopy | 403 | 302–504 | Gamma (403; SD 50) | CPT 45378, CMS |
| Esophagogastroduodenoscopy | 305 | 229–381 | Gamma (305; SD 38) | CPT 43235, CMS |
| Cost of FMT preparation and instillationb | 112 | 84–140 | Gamma (112; SD 14) | CPT G0455, CMS |
| Cost of testing recipient prior to FMT | 119 | 89–149 | Gamma (119; SD 15) | CMS |
| Cost of testing donor prior to FMT | 528 | 396–660 | Gamma (528; SD 66) | CMS |
| Colectomy | 37 629 | 28 222–47 036 | Gamma (37629; SD 4704) | [31] |
| Median cost of hospitalization for CDI | 15 675 | 14 014–17 335 | Gamma (15675; SD 830) | [4] |
| Initial outpatient visit | 105 | 79–131 | Gamma (105; SD 13) | HCPCS 99203, CMS |
| Follow-up outpatient visits | 104 | 78–130 | Gamma (104; SD 13) | HCPCS 99214, CMS |
| Clostridium difficile nucleic acid amplification testing | 50 | 37–62 | Gamma (50; SD 6) | CMS |
| Utilities | ||||
| Healthy patient, median age 65 | 0.88 | 0.84–0.92 | Triangular (0.88, 0.84, 0.92) | [33] |
| Mild-moderate CDI | 0.82 | 0.72–0.93 | Triangular (0.82, 0.72, 0.93) | [32, 34, 35, 42] |
| Severe CDI | 0.71 | 0.50–0.72 | Triangular (0.71, 0.50, 0.72) | [32, 34, 35, 42] |
| Colectomy | 0.61 (1 mo) | 0.32–0.84 | Triangular (0.61, 0.32, 0.84) | [32, 34, 35] |
| Postcolectomy | 0.86 | 0.84–0.94 | Triangular (0.86, 0.84, 0.94) | [31, 32] |
Abbreviations: bid, twice daily; CDI, Clostridium difficile infection; CMS, Centers for Medicare and Medicaid Services; CPT, Current Procedural Terminology; FMT, fecal microbiota transplant; HCPCS, Healthcare Common Procedural Coding System; IV, intravenous; qid, 4 times daily; SD, standard deviation; tid, 3 times daily.
a Outpatient oral vancomycin pulse/taper: 125 mg qid × 10 days, followed by 125 mg every 3 days for a total of 10 additional doses.
b Does not include donor or recipient testing (see Methods).