Table 1. Base case estimates, range, and distribution for model variables.
Variable | Base case value | Range | Distribution | Standard deviation | References |
---|---|---|---|---|---|
Probabilities | |||||
Oral vancomycin pulse/taper—cure | 0.771 | 0.652–0.890 | Beta | 0.061 | [8,49] |
Oral vancomycin pulse/taper—relapse | 0.568 | 0.408–0.727 | Beta | 0.081 | [8,49] |
Fidaxomicin—cure | 0.812 | 0.719–0.904 | Beta | 0.047 | [21–25,50,51] |
Fidaxomicin—relapse | 0.211 | 0.105–0.316 | Beta | 0.054 | [21–25,50,51] |
FMT colonoscopy—cure | 0.894 | 0.852–0.937 | Beta | 0.022 | [8,52–58] |
FMT colonoscopy—relapse | 0.022 | 0.001–0.043 | Beta | 0.011 | [8,52–58] |
FMT colonoscopy after second FMT—cure | 0.563 | 0.319–0.806 | Beta | 0.124 | [8,52,55–57] |
FMT duodenal infusion—cure | 0.795 | 0.723–0.867 | Beta | 0.037 | [7,26,59,60] |
FMT duodenal infusion—relapse | 0.021 | 0.000–0.049 | Beta | 0.014 | [7,26,59,60] |
FMT duodenal infusion after second FMT—cure | 0.750 | 0.326–1.174 | Beta | 0.217 | [7,26] |
FMT enema—cure | 0.833 | 0.712–0.955 | Beta | 0.062 | [61–63] |
FMT enema—relapse | 0.000 | 0.000–0.000 | Beta | 0.000 | [61–63] |
FMT enema after second FMT—cure | 0.500 | 0.100–0.900 | Beta | 0.204 | [61,63] |
Severe uncomplicated CDI | 0.180 | 0.115–0.246 | Beta | 0.033 | [64] |
Severe complicated CDI | 0.012 | 0.011–0.013 | Beta | 0.001 | [36,64] |
Colectomy | 0.318 | 0.293–0.344 | Beta | 0.013 | [36,37] |
Postcolectomy mortality | 0.407 | 0.350–0.463 | Beta | 0.029 | [37,65–67] |
Adverse events of FMT colonoscopy | 0.002 | 0.000–0.012 | Beta | 0.005 | [27–29] |
Adverse events of FMT duodenal infusion | 0.0005 | 0.000–0.002 | Beta | 0.0007 | [31] |
Mortality from FMT colonoscopy | 0.0003 | 0.0002–0.0003 | Beta | 0.00003 | [28–30,68] |
Mortality from FMT duodenal infusion | 0.0002 | 0.000–0.0004 | Beta | 0.0001 | [31] |
Hospitalization for mild CDI | 0.000 | 0.000–0.000 | Beta | 0.000 | Expert opinion |
Mortality from mild CDI | 0.007 | 0.002–0.012 | Beta | 0.002 | [69,70] |
Mortality from severe uncomplicated CDI | 0.339 | 0.221–0.457 | Beta | 0.060 | [71] |
Costsa | |||||
Oral vancomycin pulse/taperb | 58 | not varied | Local sources | ||
Fidaxomicin (200 mg bid, 10 days) | 1416 | not varied | Local sources | ||
Oral vancomycin (500 mg qid, 10 days) | 50 | not varied | Local sources | ||
Intravenous metronidazole (500 mg tid, 10 days) | 11 | not varied | Local sources | ||
Outpatient visit | 43 | not varied | Local sources | ||
Donor and stool testing prior to FMT | 825 | not varied | NABM | ||
Stool transplant preparation and traceability of samples | 154 | not varied | Local sources | ||
Oral vancomycin (500 mg qid, 4 days) prior to FMT | 20 | not varied | Local sources | ||
FMT delivery by colonoscopy | 289 | not varied | Local sources | ||
FMT delivery by duodenal infusion | 76 | not varied | Local sources | ||
FMT delivery by enema | 5 | not varied | Local sources | ||
Follow-up outpatient visits | 86 | not varied | Local sources | ||
Mean cost of hospitalization for mild-to-moderate CDI | 2190 | 2099–2280 | Gamma | 45 | [46] |
Mean cost of hospitalization for severe CDI | 8412 | 7725–9098 | Gamma | 343 | [46] |
Colectomy | 719 | not varied | CCAM | ||
Adverse events of FMT colonoscopy | 283 | not varied | CCAM | ||
Adverse events of FMT duodenal infusion | 229 | not varied | CCAM | ||
Utilities | |||||
Severe CDI (complicated or uncomplicated) | 0.600 | 0.505–0.695 | Beta | 0.156 | [47] |
Mild-to-moderate CDI | 0.782 | 0.628–0.936 | Beta | 0.154 | [48] |
Postcolectomy | 0.536 | 0.382–0.690 | Beta | 0.154 | [72] |
Adverse events of FMT colonoscopy or FMT duodenal infusion | 0.770 | 0.670–0.920 | Beta | 0.154 | [73] |
Healthy | 1 | ||||
Death | 0 |
Abbreviations: bid: twice daily; CCAM: French Common Classification of Medical Procedures; CDI: Clostridium difficile infection; FMT: fecal microbiota transplantation; NABM: French Nomenclature of Procedures in Laboratory Medicine; IV: intravenous; od: once daily; qid: 4 times daily; tid: 3 times daily.
aCosts are reported as 2016 Euros.
bOral vancomycin pulse/taper: oral vancomycin at 125 mg qid for 10 days, then 500 mg od every 2 days for 21 days.