Fidaxomicin as first line: What will it cost in the USA and Canada?
Bibliographic record
Abstract
Abstract Importance Recent changes in the Infectious Diseases and Healthcare Epidemiology Societies of America (IDSA-SHEA) guidelines for managing Clostridioides difficile infections (CDI) have placed fidaxomicin as first-line treatment. Objective To estimate the net cost of first line fidaxomicin compared to vancomycin in the American and Canadian healthcare systems and to estimate the price points at which fidaxomicin would become cost saving. In Canada, net costs were from the public payer perspective. In the US, costs were from a healthcare and payer perspective. Data sources We identified all randomized controlled trials comparing fidaxomicin with vancomycin through the 2021 IDSA-SHEA guideline update. Medication costs were obtained from internet prices (US) and the Quebec drug formulary (Canada). The average cost of a CDI recurrence was established through a systematic review for each country. Study selection For fidaxomicin efficacy, we included double-blind and placebo-controlled trials. For the systematic review of recurrence costs, studies were included if they were primary research articles, had a cost-analysis of CDI, included cases of recurrent CDI, and were calculated with cost parameters from American or Canadian healthcare systems. Studies were excluded if the population was solely pediatric or hospitalized. Data extraction and Synthesis For the efficacy meta-analysis, data was pooled using a restricted maximal likelihood random effects model. For the cost review, the mean cost across identified studies was adjusted to reflect July 2022 dollars. Main Outcomes and Measures The primary outcome of the meta-analysis was CDI recurrence at Day 40. The primary outcome of the systematic review was the average cost of a CDI recurrence in the American and Canadian healthcare systems. The objective was to estimate the net cost per recurrence prevented and the price point below which fidaxomicin would be cost saving to either the public payer (Canada) or the insurer (US). Results The estimated mean system cost of a CDI recurrence was $15147USD and $8806CAD, respectively. At current drug pricing, to prevent one recurrence by using first line fidaxomicin over vancomycin would cost $43904USD (95%CI $35123-$65856) and $13,760CAD (95%CI $11,008-$20,640), respectively. The likelihood of fidaxomicin offering cost savings varies by country, with a 95% probability of fidaxomicin being cost saving if priced below $1180USD or $860CAD respectively. Conclusions and Relevance An increased drug expenditure on fidaxomicin will not be offset through recurrence prevention unless the fidaxomicin price is negotiated.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.008 | 0.048 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.004 | 0.004 |
| Bibliometrics | 0.006 | 0.015 |
| Science and technology studies | 0.002 | 0.002 |
| Scholarly communication | 0.009 | 0.003 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.003 | 0.004 |
| Insufficient payload (model declined to judge) | 0.009 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".