Clinical infectious diseases : an official publication of the Infectious Diseases Society of America
October 1, 2026 · via Europe PMC
Cost-effectiveness of Commercial or Traditional Fecal Microbiota Transplantation for Recurrent Clostridioides difficile Infection.
Hirsch W, Enns EA, Khoruts A, Rajasingham R, Vaughn BP.
AI summary — for doctors, generated from the abstract only
In a cost-effectiveness model, FMT by colonoscopy was the best-value strategy for recurrent C. difficile infection, and commercial microbiota products were not cost-effective when donor-derived FMT is available.
What was studied
A Markov model simulating a cohort of patients with recurrent CDI to compare varied methods of FMT administration, including commercial FDA-approved microbiota therapeutics, using cure, recurrence and mortality estimates from guidelines and published literature, with QALYs and ICERs as outcomes.
Key findings
- FMT by colonoscopy was cost-effective for preventing second or subsequent recurrence, with an ICER of $44 158
- At a willingness-to-pay of $100 000 per QALY, colonoscopic FMT was optimal in 70% of simulations
- Commercial FDA-approved microbiota therapeutics were not cost-effective under any circumstance when donor-derived FMT products are available
Clinical relevance
Health systems and payers weighing access to donor-derived FMT versus commercial products may find that traditional FMT offers better value at current pricing, while commercial products matter mainly if FMT is unavailable.
Who should care
Limitations
This is a model-based analysis that depends on input assumptions drawn from the literature, and results hold at current prices that may change. The abstract does not describe the perspective, time horizon or sensitivity analyses in detail.
At current pricing, donor-derived FMT by colonoscopy is the cost-effective choice for recurrent CDI when it is available.
This is an AI-generated summary of the published abstract, not a clinical recommendation. It may not reflect the full text or subsequent updates — verify against the original source before acting on it.
Abstract
Background
Fecal microbiota transplantation (FMT) is the cost-effective strategy for managing recurrent Clostridioides difficile infection (rCDI). Prior costing models assumed FMT administration via colonoscopy. With the commercialization of microbiota therapeutics for rCDI, this study sought to determine the impact of commercial, Food and Drug Administration (FDA) approved microbiota-based therapeutics relative to traditional FMT on the cost-effectiveness for rCDI.
Methods
We used a Markov model to simulate a cohort of patients with rCDI to evaluate the cost-effectiveness of varied methods of FMT administration for rCDI. The model includes estimates of cure, recurrence, and mortality. Data sources were taken from national guidelines and published literature on treatment outcomes. Outcome measures were quality-adjusted life-years (QALYs) and incremental cost-effectiveness ratios (ICERs).
Results
FMT by colonoscopy is the cost-effective strategy for preventing second or subsequent rCDI with an incremental cost-effectiveness ratio (ICER) of $44 158. Assuming a willingness-to-pay threshold of $100 000 per quality adjusted life years (QALY) gained, FMT by colonoscopy was optimal in the majority (70%) of simulations. At a willingness-to-pay threshold of $100 000 per quality adjusted life year (QALY), commercial, FDA approved microbiota therapeutics were not cost effective under any circumstance when donor-derived FMT products are available.
Conclusions
Traditional FMT administered by colonoscopy is the optimal cost-effective strategy for preventing second or subsequent episodes of rCDI. If FMT is not available, then microbiota therapeutics are not a cost-effective option for rCDI at current pricing.
DOI
10.1093/cid/ciag263
PMID
42274997
Research metadata (titles, abstracts, authors, publication dates) is sourced from Europe PMC, which aggregates content from PubMed/MEDLINE, PubMed Central, and other providers under the U.S. National Library of Medicine (NLM/NCBI). NLM does not claim copyright on abstracts; the original journal publishers or authors may hold rights to the full articles. AI-generated summaries are derived only from the abstract, never the full text, and are always labeled as AI-generated.
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