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Cost-Effectiveness Analysis of the Use of Probiotics for the Prevention of Clostridium difficile–Associated Diarrhea in a Provincial Healthcare System

Published online by Cambridge University Press:  05 July 2016

Jenine R. Leal ,
Steven J. Heitman ,
John M. Conly ,
Elizabeth A. Henderson  and
Braden J. Manns
Jenine R. Leal*
Affiliation:
Infection Prevention and Control, Calgary and Area, Alberta Health Services (AHS), Calgary, Alberta, Canada Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
Steven J. Heitman
Affiliation:
Department of Medicine, University of Calgary and AHS, Calgary, Alberta, Canada O’Brien Institute for Public Health, University of Calgary and AHS, Calgary, Alberta, Canada
John M. Conly
Affiliation:
Department of Medicine, University of Calgary and AHS, Calgary, Alberta, Canada O’Brien Institute for Public Health, University of Calgary and AHS, Calgary, Alberta, Canada Department of Pathology and Laboratory Medicine, University of Calgary and AHS, Calgary, Alberta, Canada Snyder Institute for Chronic Diseases, University of Calgary and AHS, Calgary, Alberta, Canada Department of Microbiology, Immunology and Infectious Diseases, University of Calgary, Calgary, Alberta, Canada
Elizabeth A. Henderson
Affiliation:
Infection Prevention and Control, Calgary and Area, Alberta Health Services (AHS), Calgary, Alberta, Canada Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada O’Brien Institute for Public Health, University of Calgary and AHS, Calgary, Alberta, Canada
Braden J. Manns
Affiliation:
Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada Department of Medicine, University of Calgary and AHS, Calgary, Alberta, Canada O’Brien Institute for Public Health, University of Calgary and AHS, Calgary, Alberta, Canada
*
Address correspondence to Jenine R. Leal, MSc, Infection Prevention and Control, Alberta Health Services, Foothills Medical Centre, 801-South Tower, 1403-29th St NW, Calgary, Alberta T2N 2T9 (Jenine.leal@albertahealthservices.ca).
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Abstract

OBJECTIVE

To conduct a full economic evaluation assessing the costs and consequences related to probiotic use for the primary prevention of Clostridium difficile–associated diarrhea (CDAD).

DESIGN

Cost-effectiveness analysis using decision analytic modeling.

METHODS

A cost-effectiveness analysis was used to evaluate the risk of CDAD and the costs of receiving oral probiotics versus not over a time horizon of 30 days. The target population modeled was all adult inpatients receiving any therapeutic course of antibiotics from a publicly funded healthcare system perspective. Effectiveness estimates were based on a recent systematic review of probiotics for the primary prevention of CDAD. Additional estimates came from local data and the literature. Sensitivity analyses were conducted to assess how plausible changes in variables impacted the results.

RESULTS

Treatment with oral probiotics led to direct costs of CDN $24 per course of treatment per patient. On average, patients treated with oral probiotics had a lower overall cost compared with usual care (CDN $327 vs $845). The risk of CDAD was reduced from 5.5% in those not receiving oral probiotics to 2% in those receiving oral probiotics. These results were robust to plausible variation in all estimates.

CONCLUSIONS

Oral probiotics as a preventive strategy for CDAD resulted in a lower risk of CDAD as well as cost-savings. The cost-savings may be greater in other healthcare systems that experience a higher incidence and cost associated with CDAD.

Infect Control Hosp Epidemiol 2016;37:1079–1086

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 37 , Issue 9 , September 2016 , pp. 1079 - 1086
Copyright
© 2016 by The Society for Healthcare Epidemiology of America. All rights reserved 

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