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Herbin SR, Crum H, Gens K. Breaking the Cycle of Recurrent Clostridioides difficile Infections: A Narrative Review Exploring Current and Novel Therapeutic Strategies. J Pharm Pract 2024:8971900241248883. [PMID: 38739837 DOI: 10.1177/08971900241248883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2024]
Abstract
Clostridioides difficile is a toxin-producing bacteria that is a main cause of antibiotic-associated diarrhea. Clostridioides difficile infections (CDI) are associated with disruptions within the gastrointestinal (GI) microbiota which can be further exacerbated by CDI-targeted antibiotic treatment thereby causing recurrent CDI (rCDI) and compounding the burden placed on patients and the healthcare system. Treatment of rCDI consists of antibiotics which can be paired with preventative therapeutics, such as bezlotoxumab or fecal microbiota transplants (FMTs), if sustained clinical response is not obtained. Newer preventative strategies have been recently approved to assist in restoring balance within the GI system with the goal of preventing recurrent infections.
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Affiliation(s)
- Shelbye R Herbin
- Antimicrobial Stewardship and Medication Safety, John D. Dingell VA Medical Center, Detroit, MI, USA
| | - Hannah Crum
- Mercy Hospital Southeast, Cape Girardeau, MO, USA
| | - Krista Gens
- Allina Health, Minneapolis, MN, USA
- Abbott Northwestern Hospital, Minneapolis, MN, USA
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Ghosh S, Antunes A, Rinta-Kokko H, Chaparova E, Lay-Flurrie S, Tricotel A, Andersson FL. Clostridioides difficile infections, recurrences, and clinical outcomes in real-world settings from 2015 to 2019: The RECUR England study. Int J Infect Dis 2024; 140:31-38. [PMID: 38185320 DOI: 10.1016/j.ijid.2024.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 12/27/2023] [Accepted: 01/02/2024] [Indexed: 01/09/2024] Open
Abstract
OBJECTIVE To estimate the epidemiological and clinical burden of Clostridioides difficile infections (CDIs) and recurrences (rCDIs) in England. METHODS This retrospective study included adult patients diagnosed with CDI (community or hospital settings) over 2015-2019 from Clinical Practice Research Datalink and Hospital Episode Statistics databases. Incidences of CDI and rCDI were determined annually. Time to subsequent rCDI was estimated by Kaplan-Meier method. Rates of complications were assessed within 12 months from index episode. Association of risk factors with complications was evaluated using a Cox regression model. RESULTS A total of 52,443 CDI episodes were recorded among 36,913 patients. Of these, 75% were aged ≥65 years, 59% were women; 73% were treated in community settings. CDI incidence remained stable (111 episodes per 100,000 patients in 2019). Around 21% of patients had ≥1 rCDI. Sepsis (12%) was the most common complication, followed by colectomy and ulcerative colitis. Age, gender, comorbidities, rCDI, preindex medical procedures, hospitalizations and consultations, and CDI treatment in hospital, were found to increase the risk of complication. CONCLUSIONS CDI remains a concern in England. The study highlights the importance of managing primary and rCDI episodes via effective and improved therapies to prevent fatal complications.
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Affiliation(s)
- Subrata Ghosh
- College of Medicine and Health, University College Cork, Cork, Ireland; University of Birmingham, Birmingham, UK
| | - Ana Antunes
- IQVIA, Global Database Studies, Real World Solutions, Lisbon, Portugal.
| | - Hanna Rinta-Kokko
- IQVIA, Global Database Studies, Real World Solutions, Espoo, Finland
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Carlson J, Foos V, Kasle A, Mugwagwa T, Draica F, Lee Wiemken T, Nguyen JL, Cha-Silva A, Migliaccio-Walle K, Dzingina M. Cost-Effectiveness of Oral Nirmatrelvir/Ritonavir in Patients at High Risk for Progression to Severe COVID-19 in the United States. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2024; 27:164-172. [PMID: 38043712 DOI: 10.1016/j.jval.2023.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 10/27/2023] [Accepted: 11/22/2023] [Indexed: 12/05/2023]
Abstract
OBJECTIVES Nirmatrelvir/ritonavir (NMV/r) is an orally administered antiviral indicated for the outpatient treatment of patients with mild-to-moderate COVID-19 at high risk for disease progression to severe illness. We estimated the cost-effectiveness of NMV/r versus best supportive care for patients with mild-to-moderate COVID-19 at high risk for progression to severe illness from a US health sector perspective. METHODS A cost-effectiveness model was developed using a short-term decision-tree (1 year) followed by a lifetime 2-state Markov model (alive and dead). The short-term decision-tree captured costs and outcomes associated with the primary infection and healthcare utilization; survivors of the short-term decision-tree were followed until death assuming US quality-adjusted life years (QALYs), adjusted in the short-term for survivors of mechanical ventilation. Baseline rate of hospitalization and NMV/r effectiveness were taken from an Omicron-era US real-world study. Remaining inputs were informed by previous COVID-19 studies and publicly available US sources. Sensitivity analyses were conducted for all model inputs to test the robustness of model results. RESULTS NMV/r was found to decrease COVID-19 related hospitalizations (-0.027 per infected case) increase QALYs (+0.030), decrease hospitalization costs (-$1110), and increase total treatment cost (+$271), resulting in an incremental cost-effectiveness ratio of $8931/QALY. Results were most sensitive to baseline risk of hospitalization and NMV/r treatment effectiveness parameters. The probabilistic analysis indicated that NMV/r has a >99% probability of being cost-effective at a $100 000 willingness-to-pay threshold. CONCLUSIONS NMV/r is cost-effective vs best supportive care for patients at high risk for severe COVID-19 from a US health sector perspective.
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Affiliation(s)
- Josh Carlson
- Curta, Inc, Seattle, Washington, USA; The Comparative Health Outcomes, Policy, and Economics (CHOICE) Institute, University of Washington, Seattle, Washington, USA
| | - Volker Foos
- Health Economics and Outcomes Research, Ltd, Cardiff, Wales, UK
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Uno S, Goto R, Honda K, Uchida S, Uwamino Y, Namkoong H, Yoshifuji A, Mikita K, Takano Y, Matsumoto M, Kitagawa Y, Hasegawa N. Cost-Effectiveness of Universal Asymptomatic Preoperative SARS-CoV-2 Polymerase Chain Reaction Screening: A Cost-Utility Analysis. Clin Infect Dis 2024; 78:57-64. [PMID: 37556365 PMCID: PMC10810706 DOI: 10.1093/cid/ciad463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 07/31/2023] [Accepted: 08/04/2023] [Indexed: 08/11/2023] Open
Abstract
BACKGROUND An early report has shown the clinical benefit of the asymptomatic preoperative severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) screening test, and some clinical guidelines recommended this test. However, the cost-effectiveness of asymptomatic screening was not evaluated. We aimed to investigate the cost-effectiveness of universal preoperative screening of asymptomatic patients for SARS-CoV-2 using polymerase chain reaction (PCR) testing. METHODS We evaluated the cost-effectiveness of asymptomatic screening using a decision tree model from a payer perspective, assuming that the test-positive rate was 0.07% and the screening cost was 8500 Japanese yen (JPY) (approximately 7601 US dollars [USD]). The input parameter was derived from the available evidence reported in the literature. A willingness-to-pay threshold was set at 5 000 000 JPY/quality-adjusted life-year (QALY). RESULTS The incremental cost of 1 death averted was 74 469 236 JPY (approximately 566 048 USD) and 291 123 368 JPY/QALY (approximately 2 212 856 USD/QALY), which was above the 5 000 000 JPY/QALY willingness-to-pay threshold. The incremental cost-effectiveness ratio fell below 5 000 000 JPY/QALY only when the test-positive rate exceeded 0.739%. However, when the probability of developing a postoperative pulmonary complication among SARS-CoV-2-positive patients was below 0.22, asymptomatic screening was never cost-effective, regardless of how high the test-positive rate became. CONCLUSIONS Asymptomatic preoperative universal SARS-CoV-2 PCR screening is not cost-effective in the base case analysis. The cost-effectiveness mainly depends on the test-positive rate, the frequency of postoperative pulmonary complications, and the screening costs; however, no matter how high the test-positive rate, the cost-effectiveness is poor if the probability of developing postoperative pulmonary complications among patients positive for SARS-CoV-2 is sufficiently reduced.
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Affiliation(s)
- Shunsuke Uno
- Department of Infectious Diseases, Keio University School of Medicine, Tokyo, Japan
- Health Technology Assessment Unit, Department of Preventive Medicine and Public Health, Keio University School of Medicine, Tokyo, Japan
| | - Rei Goto
- Health Technology Assessment Unit, Department of Preventive Medicine and Public Health, Keio University School of Medicine, Tokyo, Japan
- Graduate School of Business Administration, Keio University, Kanagawa, Japan
- Graduate School of Health Management, Keio University, Kanagawa, Japan
| | - Kimiko Honda
- Health Technology Assessment Unit, Department of Preventive Medicine and Public Health, Keio University School of Medicine, Tokyo, Japan
- Graduate School of Health Management, Keio University, Kanagawa, Japan
- Center of Health Economics and Health Technology Assessment, Keio University Global Research Institute, Tokyo, Japan
| | - Sho Uchida
- Department of Infectious Diseases, Keio University School of Medicine, Tokyo, Japan
| | - Yoshifumi Uwamino
- Department of Laboratory Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Ho Namkoong
- Department of Infectious Diseases, Keio University School of Medicine, Tokyo, Japan
| | - Ayumi Yoshifuji
- Department of Infectious Diseases, Keio University School of Medicine, Tokyo, Japan
| | - Kei Mikita
- Department of Infectious Diseases, Keio University School of Medicine, Tokyo, Japan
| | - Yaoko Takano
- Division of Infectious Diseases and Infection Control, Keio University Hospital, Tokyo, Japan
| | - Morio Matsumoto
- Department of Orthopedics, Keio University School of Medicine, Tokyo, Japan
| | - Yuko Kitagawa
- Department of Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Naoki Hasegawa
- Department of Infectious Diseases, Keio University School of Medicine, Tokyo, Japan
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Feuerstadt P, Allegretti JR, Dubberke ER, Guo A, Harvey A, Yang M, Garcia-Horton V, Fillbrunn M, Tillotson G, Bancke LL, LaPlante K, Garey KW, Khanna S. Efficacy and Health-Related Quality of Life Impact of Fecal Microbiota, Live-jslm: A Post Hoc Analysis of PUNCH CD3 Patients at First Recurrence of Clostridioides difficile Infection. Infect Dis Ther 2024; 13:221-236. [PMID: 38236515 PMCID: PMC10828144 DOI: 10.1007/s40121-023-00907-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 12/14/2023] [Indexed: 01/19/2024] Open
Abstract
INTRODUCTION Clostridioides difficile infection (CDI) causes symptoms of varying severity and negatively impacts patients' health-related quality of life (HRQL). Despite antibiotic treatment, recurrence of CDI (rCDI) is common and imposes clinical and economic burdens on patients. Fecal microbiota, live-jslm (REBYOTA [RBL]) is newly approved in the USA for prevention of rCDI following antibiotic treatments. We analyzed efficacy and HRQL impact of RBL vs. placebo in patients at first rCDI using data from the phase 3 randomized, double-blind placebo-controlled clinical trial, PUNCH CD3. METHODS This post hoc analysis included patients at first rCDI fromPUNCH CD3. Treatment success (i.e., absence of diarrhea within 8 weeks post-treatment) was analyzed adjusting for baseline patient characteristics. HRQL was measured using the Clostridioides difficile Quality of Life Survey (Cdiff32); absolute scores and change from baseline in total and domain (physical, mental, and social) scores were summarized and compared between arms. Analyses were conducted for the trial's blinded phase only. RESULTS Among 86 eligible patients (32.8% of the overall trial population, RBL 53 [61.6%], placebo 33 [38.4%]), RBL-treated patients had significantly lower odds of recurrence (i.e., greater probability of treatment success) at week 8 vs. placebo (odds ratio 0.35 [95% confidence interval 0.13, 0.98]). Probability of treatment success at week 8 was 81% for RBL and 60% for placebo, representing 21% absolute and 35% relative increases for RBL (crude proportions 79.2% vs. 60.6%; relative risk 0.53, p = 0.06). Additionally, RBL was associated with significantly higher Cdiff32 total (change score difference 13.5 [standard deviation 5.7], p < 0.05) and mental domain (16.2 [6.0], p < 0.01) scores vs. placebo from baseline to week 8. CONCLUSION Compared to placebo, RBL demonstrated a significantly higher treatment success in preventing further rCDI and enhanced HRQL among patients at first recurrence, establishing RBL as an effective treatment to prevent further recurrences in these patients. TRIAL REGISTRATION ClinicalTrials.gov Identifier NCT03244644.
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Affiliation(s)
- Paul Feuerstadt
- Yale University School of Medicine, New Haven, CT, USA.
- PACT-Gastroenterology Center, 2200 Whitney Avenue Suite 330 & 360, Hamden, CT, 06518, USA.
| | | | | | - Amy Guo
- Ferring Pharmaceuticals, Inc, Parsippany, NJ, USA
| | - Adam Harvey
- Rebiotix, a Ferring Company, Roseville, MN, USA
| | - Min Yang
- Analysis Group, Inc., Boston, MA, USA
- University of Texas at Austin, Austin, TX, USA
| | | | | | | | | | - Kerry LaPlante
- University of Rhode Island, Kingston, RI, USA
- Warren Alpert Medical School of Brown University, Providence, RI, USA
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Ong SWX, Zhabokritsky A, Daneman N, Tong SYC, Wijeysundera HC. Evaluating the use of fluorine-18 fluorodeoxyglucose positron emission tomography/computed tomography in the workup of Staphylococcus aureus bacteraemia: a cost-utility analysis. Clin Microbiol Infect 2023; 29:1417-1423. [PMID: 37353076 DOI: 10.1016/j.cmi.2023.06.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Revised: 06/12/2023] [Accepted: 06/17/2023] [Indexed: 06/25/2023]
Abstract
OBJECTIVES The use of positron emission tomography/computed tomography (PET/CT) in the evaluation of patients with Staphylococcus aureus bacteraemia can improve the diagnosis of infectious foci and guide clinical management. We aimed to evaluate the cost-utility of PET/CT among adults hospitalized with Staphylococcus aureus bacteraemia. METHODS A cost-utility analysis was conducted from the healthcare payer perspective using a probabilistic Markov cohort model assessing three diagnostic strategies: (a) PET/CT in all patients, (b) PET/CT in high-risk patients only, and (c) routine diagnostic workup. Primary outcomes were quality-adjusted life years (QALYs), costs in Canadian dollars, and an incremental cost-effectiveness ratio. Deterministic and probabilistic sensitivity analyses were conducted to evaluate parameter uncertainty. RESULTS Routine workup resulted in an average of 16.64 QALYs from the time of diagnosis at a lifetime cost of $209 060/patient. This was dominated by PET/CT in high-risk patients (i.e. greater effectiveness at lower costs) with average 16.88 QALYs at a cost of $199 552. Compared with PET/CT in high-risk patients only, PET/CT for all patients cost on average $11 960 more but resulted in 0.14 more QALYs, giving an incremental cost-effectiveness ratio of $83 500 (cost per additional QALY gained); however, there was a high degree of uncertainty comparing these two strategies. At a willingness-to-pay threshold of $50 000/QALY, PET/CT in high-risk patients was the most cost-effective strategy in 58.6% of simulations vs. 37.9% for PET/CT in all patients. DISCUSSION Our findings suggest that a strategy of using PET/CT in high-risk patients is more cost-effective than no PET/CT. Randomized controlled trials should be conducted to evaluate the use of PET/CT in different patient groups.
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Affiliation(s)
- Sean W X Ong
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada; Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia.
| | - Alice Zhabokritsky
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada; Department of Medicine, Division of Infectious Diseases, University Health Network, Toronto, ON, Canada
| | - Nick Daneman
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada; Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Steven Y C Tong
- Department of Infectious Diseases, University of Melbourne, Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia; Victorian Infectious Diseases Service, Royal Melbourne Hospital, Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | - Harindra C Wijeysundera
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada; Sunnybrook Health Sciences Centre, Toronto, ON, Canada
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Fernandez-Cotarelo MJ, Jackson-Akers JY, Nagy-Agren SE, Warren CA. Interaction of Clostridioides difficile infection with frailty and cognition in the elderly: a narrative review. Eur J Med Res 2023; 28:439. [PMID: 37849008 PMCID: PMC10580652 DOI: 10.1186/s40001-023-01432-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Accepted: 10/05/2023] [Indexed: 10/19/2023] Open
Abstract
PURPOSE Clostridioides difficile infection (CDI) is the leading cause of antibiotic-related diarrhea and healthcare-associated infections, affecting in particular elderly patients and their global health. This review updates the understanding of this infection, with focus on cognitive impairment and frailty as both risk factors and consequence of CDI, summarizing recent knowledge and potential mechanisms to this interplay. METHODS A literature search was conducted including terms that would incorporate cognitive and functional impairment, aging, quality of life, morbidity and mortality with CDI, microbiome and the gut-brain axis. RESULTS Advanced age remains a critical risk for severe disease, recurrence, and mortality in CDI. Observational and quality of life studies show evidence of functional loss in older people after acute CDI. In turn, frailty and cognitive impairment are independent predictors of death following CDI. CDI has long-term impact in the elderly, leading to increased risk of readmissions and mortality even months after the acute event. Immune senescence and the aging microbiota are key in susceptibility to CDI, with factors including inflammation and exposure to luminal microbial products playing a role in the gut-brain axis. CONCLUSIONS Frailty and poor health status are risk factors for CDI in the elderly. CDI affects quality of life, cognition and functionality, contributing to a decline in patient health over time and leading to early and late mortality. Narrative synthesis of the evidence suggests a framework for viewing the cycle of functional and cognitive decline in the elderly with CDI, impacting the gut-brain and gut-muscle axes.
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Affiliation(s)
- Maria-Jose Fernandez-Cotarelo
- Department of Internal Medicine, Hospital Universitario de Mostoles, Faculty of Health Sciences, Universidad Rey Juan Carlos, Calle Doctor Luis Montes S/N, Mostoles, 28935, Madrid, Spain.
| | - Jasmine Y Jackson-Akers
- División of Infectious Disease and International Health, University of Virginia, Charlottesville, VA, USA
| | - Stephanie E Nagy-Agren
- Section of Infectious Diseases, Salem Veterans Affairs Medical Center, Virginia Tech Carilion School of Medicine, Roanoke, VA, USA
| | - Cirle A Warren
- Division of Infectious Disease and International Health, University of Virginia, Charlottesville, VA, USA
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Sun X, Di Fusco M, Puzniak L, Coetzer H, Zamparo JM, Tabak YP, Cappelleri JC. Assessment of retrospective collection of EQ-5D-5L in a US COVID-19 population. Health Qual Life Outcomes 2023; 21:103. [PMID: 37679771 PMCID: PMC10486034 DOI: 10.1186/s12955-023-02187-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 08/30/2023] [Indexed: 09/09/2023] Open
Abstract
BACKGROUND It is imperative to evaluate health related quality of life (HRQoL) pre-COVID-19, but there is currently no evidence of the retrospective application of the EuroQol 5-Dimension, 5 level version (EQ-5D-5L) for COVID-19 studies. METHODS Symptomatic patients with SARS-CoV-2 at CVS Health US test sites were recruited between 01/31/2022-04/30/2022. Consented participants completed the EQ-5D-5L questionnaire twice: a modified version where all the questions were past tense to retrospectively assess pre-COVID-19 baseline QoL, and the standard version in present tense to assess current HRQoL. Duncan's new multiple range test was adopted for post analysis of variance pairwise comparisons of EQ visual analog scale (EQ VAS) means between problem levels for each of 5 domains. A linear mixed model was applied to check whether the relationship between EQ VAS and utility index (UI) was consistent pre-COVID-19 and during COVID-19. Matching-adjusted indirect comparison was used to compare pre-COVID-19 UI and EQ VAS scores with those of the US population. Lastly, Cohen's d was used to quantify the magnitude of difference in means between two groups. RESULTS Of 676 participants, 10.2% were age 65 or more years old, 73.2% female and 71.9% white. Diabetes was reported by 4.7% participants and hypertension by 11.2%. The estimated coefficient for the interaction of UI-by-retrospective collection indicator (0 = standard prospective collection, 1 = retrospective for pre-COVID-19), -4.2 (SE: 3.2), P = 0.197, indicates that retrospective collection does not significantly alter the relationship between EQ VAS and UI. After adjusting for age, gender, diabetes, hypertension, and percent of mobility problems, the predicted means of pre-COVID-19 baseline EQ VAS and UI were 84.6 and 0.866, respectively. Both means were close to published US population norms (80.4 and 0.851) compared to those observed (87.4 and 0.924). After adjusting for age, gender, diabetes, and hypertension, the calculated ES between pre-COVID-19 and COVID-19 for UI and EQ VAS were 0.15 and 0.39, respectively. Without retrospectively collected EQ-5D-5L, using US population norms tended to underestimate the impact of COVID-19 on HRQoL. CONCLUSION At a group level the retrospectively collected pre-COVID-19 EQ-5D-5L is adequate and makes it possible to directly evaluate the impact of COVID-19 on HRQoL. ( ClinicalTrials.gov NCT05160636).
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Affiliation(s)
- Xiaowu Sun
- Clinical Trial Services, CVS Health, Woonsocket, RI, USA.
| | - Manuela Di Fusco
- Pfizer Inc, Health Economics and Outcomes Research, New York, NY, USA
| | | | | | | | - Ying P Tabak
- Clinical Trial Services, CVS Health, Woonsocket, RI, USA
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Garey KW, Dubberke ER, Guo A, Harvey A, Yang M, García-Horton V, Fillbrunn M, Wang H, Tillotson GS, Bancke LL, Feuerstadt P. Effect of Fecal Microbiota, Live-Jslm (REBYOTA [RBL]) on Health-Related Quality of Life in Patients With Recurrent Clostridioides difficile Infection: Results From the PUNCH CD3 Clinical Trial. Open Forum Infect Dis 2023; 10:ofad383. [PMID: 37564743 PMCID: PMC10411038 DOI: 10.1093/ofid/ofad383] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 07/18/2023] [Indexed: 08/12/2023] Open
Abstract
Background Recurrence of Clostridioides difficile infection (rCDI) is common, prolonging disease morbidity and leading to poor quality of life. We evaluated disease-specific health-related quality of life (HRQL) in patients with rCDI treated with fecal microbiota, live-jslm (REBYOTA [RBL]; Rebiotix) versus placebo. Methods This was a secondary analysis of a randomized, double-blind, placebo-controlled phase 3 study (PUNCH CD3). The disease-specific Clostridioides difficile Quality of Life Survey (Cdiff32) was administered at baseline and at weeks 1, 4, and 8. Changes in Cdiff32 total and domain (physical, mental, social) scores from baseline to week 8 were compared between RBL and placebo and for responders and nonresponders. Results Findings were analyzed in a total of 185 patients (RBL, n = 128 [69.2%]; placebo, n = 57 [30.8%]) with available Cdiff32 data. Patients from both arms showed significant improvements in Cdiff32 scores relative to baseline across all outcomes and at all time points (all P < .001); RBL-treated patients showed significantly greater improvements in mental domain than those receiving placebo. In adjusted analyses, RBL-treated patients showed greater improvements than placebo in total score and physical and mental domains (all P < .05). Similar improvement in mental domain was observed among responders, while nonresponders showed numerical improvements with RBL but not placebo. Conclusions In a phase 3 double-blinded clinical trial, RBL-treated patients reported more substantial and sustained disease-specific HRQL improvements than placebo-treated patients. Clinical Trials Registration ClinicalTrials.gov NCT03244644 (https://clinicaltrials.gov/ct2/show/NCT03244644).
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Affiliation(s)
| | | | - Amy Guo
- Ferring Pharmaceuticals, Parsippany, New Jersey, USA
| | - Adam Harvey
- Rebiotix, a Ferring Company, Roseville, Minnesota, USA
| | - Min Yang
- Analysis Group Inc., Boston, Massachusetts, USA
| | | | | | | | | | | | - Paul Feuerstadt
- Yale University School of Medicine, New Haven, Connecticut, USA
- PACT-Gastroenterology Center, New Haven, Connecticut, USA
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10
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Armstrong EP, Malone DC, Franic DM, Pham SV, Gratie D, Amin A. Patient Experiences with Clostridioides difficile Infection and Its Treatment: A Systematic Literature Review. Infect Dis Ther 2023:10.1007/s40121-023-00833-x. [PMID: 37395984 PMCID: PMC10390453 DOI: 10.1007/s40121-023-00833-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 06/01/2023] [Indexed: 07/04/2023] Open
Abstract
INTRODUCTION Clostridioides difficile infection (CDI) is a globally recognized cause of morbidity and mortality with devastating effects on health-related quality of life (HRQoL). The objective of this study was to conduct the first systematic literature review (SLR) to assess the humanistic burden of CDI on patient experiences, including HRQoL and related constructs, and attitudes towards treatment alternatives. METHODS An SLR was conducted to identify peer-reviewed articles that assessed CDI, including recurrent CDI (rCDI), and patient-reported outcomes or HRQoL. PubMed, Embase, and the Cochrane Collaboration abstracting services were used to conduct literature searches from 2010 to 2021 in the English language. This SLR was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) criteria. RESULTS Of 511 identified articles, 21 met study inclusion criteria. The SLR showed CDI has a devastating impact on patients' overall HRQoL that continues well beyond infection clearance. The impact of CDI on physical, emotional, social, and professional well-being rivaled abdominal symptoms of uncontrollable diarrhea, being worse for patients with rCDI. Patients with CDI feel isolated, depressed, lonely, and continue to be frightened of recurrences as well as being contagious to others. Most believe that they will never be free of CDI. CONCLUSION CDI and rCDI are debilitating conditions affecting physical, psychological, social, and professional functioning of patients' HRQoL, even long after the event has occurred. The results of this SLR suggest that CDI is a devastating condition in need of better prevention strategies, improved psychological support, and treatments that address the microbiome disruption to break the cycle of recurrence. Additional safe and effective therapies are needed to address this unmet medical need.
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Affiliation(s)
- Edward P Armstrong
- Strategic Therapeutics and University of Arizona College of Pharmacy, Tucson, AZ, USA
| | - Daniel C Malone
- Strategic Therapeutics and University of Utah College of Pharmacy, Salt Lake City, UT, USA
| | - Duska M Franic
- Evidence Institute AESARA, P.O. Box 4266, Chapel Hill, NC, 27515, USA.
| | - Sissi V Pham
- Evidence Institute AESARA, P.O. Box 4266, Chapel Hill, NC, 27515, USA
| | - Dan Gratie
- Evidence Institute AESARA, P.O. Box 4266, Chapel Hill, NC, 27515, USA
| | - Alpesh Amin
- Medicine, Business, Public Health, Nursing Science, & Biomedical Engineering, Hospitalist Program, University of California, Irvine, Irvine, CA, USA
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Di Fusco M, Marczell K, Thoburn E, Wiemken TL, Yang J, Yarnoff B. Public health impact and economic value of booster vaccination with Pfizer-BioNTech COVID-19 vaccine, bivalent (original and omicron BA.4/BA.5) in the United States. J Med Econ 2023; 26:509-524. [PMID: 36942976 DOI: 10.1080/13696998.2023.2193067] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/23/2023]
Abstract
OBJECTIVE To assess the public health impact and economic value of booster vaccination with the Pfizer-BioNTech COVID-19 Vaccine, Bivalent in the United States. METHODS A combined cohort Markov decision tree model estimated the cost-effectiveness and budget impact of booster vaccination compared to no booster vaccination in individuals aged ≥5 years. Analyses prospectively assessed three scenarios (base case, low, high) defined based upon the emergence (or not) of subvariants, using list prices. Age-stratified parameters were informed by literature. The cost-effectiveness analysis estimated cases, hospitalizations and deaths averted, Life Years (LYs) and Quality Adjusted Life Years (QALYs) gained, the incremental cost-effectiveness ratio (ICER), the net monetary benefit (NMB), and the Return on Investment (ROI). The budget impact analyses used the perspective of a hypothetical 1-million-member plan. Sensitivity analyses explored parameter uncertainty. Conservatively, indirect effects and broad societal benefits were not considered. RESULTS The base case predicted that, compared to no booster vaccination, the Pfizer-BioNTech COVID-19 Vaccine, Bivalent could result in ∼3.7 million fewer symptomatic cases, 162 thousand fewer hospitalizations, 45 thousand fewer deaths, 373 thousand fewer discounted QALYs lost, and was cost-saving. Using a conservative value of $50,000 for 1 LY, every $1 invested yielded estimated $4.67 benefits. Unit costs, health outcomes and effectiveness had the greatest impact on results. At $50,000 per QALY gained, the booster generated a 34.2 billion NMB and probabilistic sensitivity analyses indicated a 92% chance of being cost-saving and 98% of being cost-effective. The bivalent was cost-saving or highly cost-effective in high and low scenarios. In a hypothetical 1-million-member health plan population, the vaccine was predicted to be a budget-efficient solution for payers. CONCLUSIONS Booster vaccination with the Pfizer-BioNTech COVID-19 Vaccine, Bivalent for the US population aged ≥5 years could generate notable public health impact and be cost-saving based on the findings of our base case analyses.
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Affiliation(s)
| | - Kinga Marczell
- Evidera, Bocskai út 134-146, Dorottya Udvar, E épület 2. emelet, Budapest, Hungary
| | | | | | - Jingyan Yang
- Pfizer Inc., New York, NY USA
- Institute for Social and Economic Research and Policy, Columbia University, New York, NY, USA
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12
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Feuerstadt P, Theriault N, Tillotson G. The burden of CDI in the United States: a multifactorial challenge. BMC Infect Dis 2023; 23:132. [PMID: 36882700 PMCID: PMC9990004 DOI: 10.1186/s12879-023-08096-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 02/16/2023] [Indexed: 03/09/2023] Open
Abstract
Clostridioides difficile infection (CDI) affects approximately 500,000 patients annually in the United States, of these around 30,000 will die. CDI carries significant burdens including clinical, social and economic. While healthcare-associated CDI has declined in recent years, community-associated CDI is on the rise. Many patients are also impacted by recurrent C. difficile infections (rCDI); up to 35% of index CDI will recur and of these up to 60% will further recur with multiple recurrences observed. The range of outcomes adversely affected by rCDI is significant and current standard of care does not alter these recurrence rates due to the damaged gut microbiome and subsequent dysbiosis. The clinical landscape of CDI is changing, we discuss the impact of CDI, rCDI, and the wide range of financial, social, and clinical outcomes by which treatments should be evaluated.
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Affiliation(s)
- Paul Feuerstadt
- Division of Digestive Disease, PACT-Gastroenterology Center, Yale University School of Medicine, Hamden, CT, USA
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13
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Lapin B, Garey KW, Wu H, Pham SV, Huang SP, Reese PR, Wang E, Deshpande A. Validation of a Health-Related Quality of Life Questionnaire in Patients With Recurrent Clostridioides difficile Infection in ECOSPOR III, a Phase 3 Randomized Trial. Clin Infect Dis 2023; 76:e1195-e1201. [PMID: 35789381 DOI: 10.1093/cid/ciac554] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 06/22/2022] [Accepted: 06/30/2022] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Debilitating symptoms of recurrent Clostridioides difficile infection (rCDI) often lead to long-term effects on health-related quality-of-life (HRQOL). In ECOSPOR III, SER-109, an investigational oral microbiome therapeutic, was superior to placebo in reducing rCDI. We investigated the validity, reliability, and responsiveness of a 32-item, CDI-specific questionnaire-the Clostridium difficile Quality of Life Survey (Cdiff32)-across mental, physical, and social domains in patients with rCDI. METHODS In this post hoc analysis of a phase 3 clinical trial, 182 outpatients with rCDI completed Cdiff32 and EQ-5D at baseline and at 1 and 8 weeks. Cdiff32 was evaluated for item performance, internal reliability, and convergent validity. To assess known-groups validity, Cdiff32 scores were compared by disease recurrence status at week 1; internal responsiveness was evaluated in the nonrecurrent disease group by 8 weeks by means of paired t test. RESULTS All 182 patients (mean age [standard deviation], 65.5 [16.5] years; 59.9% female) completed baseline Cdiff32. Confirmatory factor analysis identified 3 domains (physical, mental, and social relationships) with good item fit. High internal reliability was demonstrated (Cronbach α = 0.94 with all subscales >0.80). Convergent validity was evidenced by significant correlations between Cdiff32 subscales and EQ-5D (r = 0.29-0.37; P < .001). Cdiff32 differentiated patients by disease recurrence status at week 1 (effect sizes, 0.38-0.42; P < .05 overall), with significant improvement from baseline through week 8 in patients with nonrecurrent disease at week 1 (effect sizes, 0.75-1.02; P < .001 overall). CONCLUSIONS Cdiff32 is a valid, reliable, and responsive disease-specific HRQOL questionnaire that is fit for purpose for interventional treatment trials. The significant improvement in patients with nonrecurrent disease by 8 weeks demonstrates the negative impact of rCDI on HRQOL.
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Affiliation(s)
- Brittany Lapin
- Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio, USA.,Center for Outcomes Research and Evaluation, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Kevin W Garey
- College of Pharmacy, University of Houston, Houston, Texas, USA
| | - Henry Wu
- Consultant, CR Medicon, Piscataway, New Jersey, USA
| | | | | | | | - Elaine Wang
- Seres Therapeutics, Cambridge, Massachusetts, USA
| | - Abhishek Deshpande
- Center for Value-Based Care Research, Cleveland Clinic Community Care, Cleveland Clinic, Cleveland, Ohio, USA.,Department of Infectious Disease, Respiratory Institute, Cleveland Clinic, Cleveland, Ohio, USA
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14
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Garey KW, Jo J, Gonzales-Luna AJ, Lapin B, Deshpande A, Wang E, Hasson B, Pham SV, Huang SP, Reese PR, Wu H, Hohmann E, Feuerstadt P, Oneto C, Berenson CS, Lee C, McGovern B, vonMoltke L. Assessment of Quality of Life Among Patients With Recurrent Clostridioides difficile Infection Treated with Investigational Oral Microbiome Therapeutic SER-109: Secondary Analysis of a Randomized Clinical Trial. JAMA Netw Open 2023; 6:e2253570. [PMID: 36716031 PMCID: PMC9887497 DOI: 10.1001/jamanetworkopen.2022.53570] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
IMPORTANCE Recurrent Clostridioides difficile infection (CDI) is a debilitating disease leading to poor health-related quality of life (HRQOL), loss of productivity, anxiety, and depression. The potential association of treatment with HRQOL has not been well evaluated. OBJECTIVES To explore the association of SER-109 compared with placebo on HRQOL in patients with recurrent CDI up to week 8. DESIGN, SETTING, AND PARTICIPANTS This study was a secondary analysis of a randomized, double-blind, placebo-controlled trial that took place at 56 sites in the US and Canada from July 2017 to April 2020 and included 182 patients randomized to SER-109 or placebo groups. INTERVENTIONS SER-109 or placebo (4 capsules once daily for 3 days) following antibiotics for CDI. MAIN OUTCOMES AND MEASURES Exploratory analysis of HRQOL using the disease specific Clostridioides difficile Quality of Life Survey (Cdiff32) assessed at baseline, week 1, and week 8. RESULTS In this study, 182 patients (109 [59.9%] female; mean age, 65.5 [16.5] years) were randomized to SER-109 (89 [48.9%]) or placebo (93 [51.1%]) groups and were included in the primary and exploratory analyses. Baseline Cdiff32 scores were similar between patients in the SER-109 and placebo groups (52.0 [18.3] vs 52.8 [18.7], respectively). The proportion of patients with overall improvement from baseline in the Cdiff32 total score was higher in the SER-109 arm than placebo at week 1 (49.4% vs 26.9%; P = .012) and week 8 (66.3% vs 48.4%; P = .001).Greater improvements in total and physical domain and subdomain scores were observed in patients in the SER-109 group compared with placebo as early as week 1, with continued improvements observed at week 8. Among patients in the placebo group, improvements in HRQOL were primarily observed in patients with nonrecurrent CDI while patients in the SER-109 group reported improvements in HRQOL, regardless of clinical outcome. CONCLUSIONS AND RELEVANCE In this secondary analysis of a phase 3 clinical trial, SER-109, an investigational microbiome therapeutic was associated with rapid and steady improvement in HRQOL compared with placebo through 8 weeks, an important patient-reported outcome. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT03183128.
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Affiliation(s)
- Kevin W. Garey
- Department of Pharmacy Practice and Translational Research, University of Houston College of Pharmacy, Houston, Texas
| | - Jinhee Jo
- Department of Pharmacy Practice and Translational Research, University of Houston College of Pharmacy, Houston, Texas
| | - Anne J. Gonzales-Luna
- Department of Pharmacy Practice and Translational Research, University of Houston College of Pharmacy, Houston, Texas
| | | | | | - Elaine Wang
- Seres Therapeutics, Inc, Cambridge, Massachusetts
| | | | | | | | | | - Henry Wu
- CR Medicon, Piscataway, New Jersey
| | | | - Paul Feuerstadt
- Yale University School of Medicine, New Haven, Connecticut
- PACT-Gastroenterology Center, Hamden, Connecticut
| | | | | | - Christine Lee
- University of British Columbia, British Columbia, Canada
- Island Medical Program, University of Victoria, British Columbia, Canada
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15
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Kohli MA, Maschio M, Joshi K, Lee A, Fust K, Beck E, Van de Velde N, Weinstein MC. The potential clinical impact and cost-effectiveness of the updated COVID-19 mRNA fall 2023 vaccines in the United States. J Med Econ 2023; 26:1532-1545. [PMID: 37961887 DOI: 10.1080/13696998.2023.2281083] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 11/06/2023] [Indexed: 11/15/2023]
Abstract
AIMS To assess the potential clinical impact and cost-effectiveness of COVID-19 mRNA vaccines updated for fall 2023 in adults aged ≥18 years over a 1-year analytic time horizon (September 2023-August 2024). MATERIALS AND METHODS A compartmental Susceptible-Exposed-Infected-Recovered model was updated to reflect COVID-19 cases in summer 2023. The numbers of symptomatic infections, COVID-19-related hospitalizations and deaths, and costs and quality-adjusted life-years (QALYs) gained were calculated using a decision tree model. The incremental cost-effectiveness ratio (ICER) of a Moderna updated mRNA fall 2023 vaccine (Moderna Fall Campaign) was compared to no additional vaccination. Potential differences between the Moderna and the Pfizer-BioNTech fall 2023 vaccines were also examined. RESULTS Base case results suggest that the Moderna Fall Campaign would decrease the expected 64.2 million symptomatic infections by 7.2 million (11%) to 57.0 million. COVID-19-related hospitalizations and deaths are expected to decline by 343,000 (-29%) and 50,500 (-33%), respectively. The Moderna Fall Campaign would increase QALYs by 740,880 and healthcare costs by $5.7 billion relative to no vaccine, yielding an ICER of $7700 per QALY gained. Using a societal cost perspective, the ICER is $2100. Sensitivity analyses suggest that vaccine effectiveness, COVID-19 incidence, hospitalization rates, and costs drive cost-effectiveness. With a relative vaccine effectiveness of 5.1% for infection and 9.8% for hospitalization for the Moderna vaccine versus the Pfizer-BioNTech vaccine, use of the Moderna vaccine is expected to prevent 24,000 more hospitalizations and 3300 more deaths than the Pfizer-BioNTech vaccine. LIMITATIONS AND CONCLUSIONS As COVID-19 becomes endemic, future incidence, including patterns of infection, are highly uncertain. The effectiveness of fall 2023 vaccines is unknown, and it is unclear when a new variant that evades natural or vaccine immunity will emerge. Despite these limitations, our model predicts the Moderna Fall Campaign vaccine is highly cost-effective across all sensitivity analyses.
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Affiliation(s)
| | | | | | - Amy Lee
- Quadrant Health Economics Inc., Cambridge, ON, Canada
| | - Kelly Fust
- Quadrant Health Economics Inc., Cambridge, ON, Canada
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16
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Perez R, Khanna S, Tillotson GS, Lett JE, Prince MA, Lattimer C. Reducing Recurrence and Complications Related to Clostridioides difficile Infection: A Panel Discussion Summary. Prof Case Manag 2022; 27:277-287. [PMID: 36206121 DOI: 10.1097/ncm.0000000000000585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND The Centers for Disease Control and Prevention identifies Clostridioides difficile infection (CDI) as an urgent threat to people and health care systems. CDI leads to high health care utilizations and results in significantly reduced quality of life for patients. The high burden of disease is seen across all health care settings, outside of the hospital, in the community, and in younger people. Individuals with CDI transition from hospitals to long-term care facilities to the community, and management of these transitions can reduce the incidence of recurrence and rehospitalization. PURPOSE The most common cause of diarrhea occurring in a health care setting is Clostridioides difficile and is also the cause of antibiotic-associated colitis (L. C. McDonald, 2021). The infection results from a disruption in the microbial flora of the gastrointestinal tract, mostly after antibiotic use or other medications such as proton pump inhibitors (PPIs). As a result, infected individuals are colonized and shed the spores into the environment, exposing others-goals of treatment focus on reducing the exposure and individual susceptibility. Although the incidence of C. diff is stable, recurrence is increasing significantly, with severe complications also a concern. The increased incidence and potential for life-threatening conditions require reducing initial exposure, supporting prescribed treatment, and preventing recurrence. PRIMARY PRACTICE SETTINGS C. diff infection can be contracted in health care facilities and in the community. Case managers from nearly all practice settings may encounter patients with the infection. FINDINGS/CONCLUSIONS To avert the devastating complications of Clostridioides difficile infection, case managers play an essential role in the prevention of recurrence with education, advocacy of best practices, effective care coordination, and thorough transitions of care. Each recurrence of C. diff infection leaves the patient vulnerable to the potential for surgical intervention, sepsis, and death. IMPLICATIONS FOR CASE MANAGEMENT Mitigating the risk for readmission and recurrence will enhance C. diff infection care, safety, and outcomes to improve a patient's health care journey and quality of life. Case managers need to take a primary role in the transition and care coordination processes, including patient and support system education, coordination of any postdischarge services, connection to providers, adherence support activities, and follow-up for improvement or changes in condition. Supportive adherence activities and prevention education can result in the avoidance of recurrence. Case managers are well-equipped to locate resources to assist those patients challenged with the cost of medications, inability to attend appointments, or access basic needs. Although not directly related to C. diff, these challenges contribute to recurrence and readmission. Mitigating risk for readmission and recurrence results in an improved quality of life.
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Affiliation(s)
- Rebecca Perez
- Rebecca Perez, MSN, RN, CCM, is an experienced RN with a master's degree in nursing, is a Certified Case Manager, and a member of the Gamma Omega Chapter of Sigma Theta Tau International Nursing Honor Society and Capella University National Society of Leadership and Success. She is the author of numerous professional articles, the primary author for the Case Management Adherence Guide 2020, co-author of CMSA's Integrated Case Management: A manual for case managers by case managers , developer of the Integrated Case Management Training Program, and Master Trainer. She joined Parthenon Management Group in 2020 as the Senior Manager of Education and Strategic Partnerships for the Case Management Society of America
- Sahil Khanna, MBBS, MS , is a gastroenterologist and hepatologist with a special interest in colonic diseases including gastrointestinal infections and the gut microbiome. • Expertise in management of primary and recurrent Clostridioides difficile infection. • Evaluation of patients for microbiome-based therapies such as fecal microbiota transplantation. • Diagnosis and management of patients with undifferentiated gastrointestinal symptoms. • Passionate about educating patients to promote their understanding of their disease
- Dr. Khanna directs the Comprehensive Gastroenterology Interest group, C . difficile Clinic, Fecal Microbiota Transplantation program and C . difficile -related Clinical Trials at Mayo Clinic, Rochester, MN. He is the practice chair for the Inpatient Gastroenterology practice and the residents' rotation director for the Internal Medicine Residency Program at Mayo Clinic, Rochester, MN
- Glenn S. Tillotson, PhD, FIDSA, FCCP, is a Partner at GST Micro, and a consultant to the pharmaceutical and diagnostic industries, providing advice on a range of topics covering preparatory and postapproval activities. Glenn has over 30 years' pharmaceutical experience in clinical research, commercialization, and scientific communications including publications planning, strategic drug development, life cycle management, and global launch programs. After training in medical microbiology and infectious diseases in the UK, Glenn spent 13 years at Bayer AG in the UK, the United States, and Germany, where he was instrumental in the development of ciprofloxacin and moxifloxacin as well as other drugs
- James E. Lett, II, MD, CMD-R , is the Medical Director for Avar Consulting in Rockville, MD, and serves as President of the National Board for the National Transitions of Care Coalition (NTOCC) in Washington, DC. Dr Lett earned his medical degree from the University of Kentucky College of Medicine, where he completed residency training. He is board-certified in Family Medicine and Geriatrics
- Dr Lett has been part of the care transitions efforts for the American Medical Association (AMA), the American Medical Directors Association (AMDA), the Society for Hospital Medicine, and the Centers for Medicare & Medicaid Services (CMS). He is a past president of the American Medical Directors Association (AMDA). He served on a CMS workgroup to revise the survey manual for nursing homes. Dr Lett has chaired a joint national effort to develop a long-term care medication toolkit for patient safety. He also chaired a national workgroup that created guidelines for care transitions in the long-term care continuum. Dr Lett participates in a National Quality Forum measures workgroup
- Melanie A. Prince, MSS, MSN, BSN, NE-BC, CCM, FAAN, is the current President of Case Management Society of America (CMSA). She is a retired Active-Duty Military Colonel who was assigned to Headquarters Air Force where she was responsible for developing strategies to eliminate interpersonal violence in the military. Melanie is now the Chief Executive Officer, Care Associates Consulting. Melanie has been a requested speaker, including annual CMSA conferences, and penned case management content, editorials, policy, and training in various publications both military and nonmilitary. A distinguished leader and mentor in her profession, she has won numerous awards including the distinguished CMSA Chapter, 2003, and National Case Manager of the Year, 2004
- Cheri Lattimer, BSN, RN, is the Executive Director for the National Transitions of Care Coalition (NTOCC) and President of Integrity Advocacy & Management. Her leadership in quality improvement, case management, care coordination, and transitions of care is known on the national and international landscape. She was a contributor and reviewer for the Case Management Society of America (CMSA) Core Curriculum for Case Management and The Integrated Case Management Manual Assisting Complex Patients Regain Physical and Mental Health. She is affiliated with many professional organizations and maintains active roles on several national boards and committees including Chair of URAC's Health Standards Committee, CMS Caregiver Workgroup, CMS Advisory Panel on Education and Outreach, the American Board of Quality Assurance and Utilization Review Physicians (ABQAURP) Board of Directors and CME Committee and an Advisory Board Member for BelleCares
| | - Sahill Khanna
- Rebecca Perez, MSN, RN, CCM, is an experienced RN with a master's degree in nursing, is a Certified Case Manager, and a member of the Gamma Omega Chapter of Sigma Theta Tau International Nursing Honor Society and Capella University National Society of Leadership and Success. She is the author of numerous professional articles, the primary author for the Case Management Adherence Guide 2020, co-author of CMSA's Integrated Case Management: A manual for case managers by case managers , developer of the Integrated Case Management Training Program, and Master Trainer. She joined Parthenon Management Group in 2020 as the Senior Manager of Education and Strategic Partnerships for the Case Management Society of America
- Sahil Khanna, MBBS, MS , is a gastroenterologist and hepatologist with a special interest in colonic diseases including gastrointestinal infections and the gut microbiome. • Expertise in management of primary and recurrent Clostridioides difficile infection. • Evaluation of patients for microbiome-based therapies such as fecal microbiota transplantation. • Diagnosis and management of patients with undifferentiated gastrointestinal symptoms. • Passionate about educating patients to promote their understanding of their disease
- Dr. Khanna directs the Comprehensive Gastroenterology Interest group, C . difficile Clinic, Fecal Microbiota Transplantation program and C . difficile -related Clinical Trials at Mayo Clinic, Rochester, MN. He is the practice chair for the Inpatient Gastroenterology practice and the residents' rotation director for the Internal Medicine Residency Program at Mayo Clinic, Rochester, MN
- Glenn S. Tillotson, PhD, FIDSA, FCCP, is a Partner at GST Micro, and a consultant to the pharmaceutical and diagnostic industries, providing advice on a range of topics covering preparatory and postapproval activities. Glenn has over 30 years' pharmaceutical experience in clinical research, commercialization, and scientific communications including publications planning, strategic drug development, life cycle management, and global launch programs. After training in medical microbiology and infectious diseases in the UK, Glenn spent 13 years at Bayer AG in the UK, the United States, and Germany, where he was instrumental in the development of ciprofloxacin and moxifloxacin as well as other drugs
- James E. Lett, II, MD, CMD-R , is the Medical Director for Avar Consulting in Rockville, MD, and serves as President of the National Board for the National Transitions of Care Coalition (NTOCC) in Washington, DC. Dr Lett earned his medical degree from the University of Kentucky College of Medicine, where he completed residency training. He is board-certified in Family Medicine and Geriatrics
- Dr Lett has been part of the care transitions efforts for the American Medical Association (AMA), the American Medical Directors Association (AMDA), the Society for Hospital Medicine, and the Centers for Medicare & Medicaid Services (CMS). He is a past president of the American Medical Directors Association (AMDA). He served on a CMS workgroup to revise the survey manual for nursing homes. Dr Lett has chaired a joint national effort to develop a long-term care medication toolkit for patient safety. He also chaired a national workgroup that created guidelines for care transitions in the long-term care continuum. Dr Lett participates in a National Quality Forum measures workgroup
- Melanie A. Prince, MSS, MSN, BSN, NE-BC, CCM, FAAN, is the current President of Case Management Society of America (CMSA). She is a retired Active-Duty Military Colonel who was assigned to Headquarters Air Force where she was responsible for developing strategies to eliminate interpersonal violence in the military. Melanie is now the Chief Executive Officer, Care Associates Consulting. Melanie has been a requested speaker, including annual CMSA conferences, and penned case management content, editorials, policy, and training in various publications both military and nonmilitary. A distinguished leader and mentor in her profession, she has won numerous awards including the distinguished CMSA Chapter, 2003, and National Case Manager of the Year, 2004
- Cheri Lattimer, BSN, RN, is the Executive Director for the National Transitions of Care Coalition (NTOCC) and President of Integrity Advocacy & Management. Her leadership in quality improvement, case management, care coordination, and transitions of care is known on the national and international landscape. She was a contributor and reviewer for the Case Management Society of America (CMSA) Core Curriculum for Case Management and The Integrated Case Management Manual Assisting Complex Patients Regain Physical and Mental Health. She is affiliated with many professional organizations and maintains active roles on several national boards and committees including Chair of URAC's Health Standards Committee, CMS Caregiver Workgroup, CMS Advisory Panel on Education and Outreach, the American Board of Quality Assurance and Utilization Review Physicians (ABQAURP) Board of Directors and CME Committee and an Advisory Board Member for BelleCares
| | - Glenn S Tillotson
- Rebecca Perez, MSN, RN, CCM, is an experienced RN with a master's degree in nursing, is a Certified Case Manager, and a member of the Gamma Omega Chapter of Sigma Theta Tau International Nursing Honor Society and Capella University National Society of Leadership and Success. She is the author of numerous professional articles, the primary author for the Case Management Adherence Guide 2020, co-author of CMSA's Integrated Case Management: A manual for case managers by case managers , developer of the Integrated Case Management Training Program, and Master Trainer. She joined Parthenon Management Group in 2020 as the Senior Manager of Education and Strategic Partnerships for the Case Management Society of America
- Sahil Khanna, MBBS, MS , is a gastroenterologist and hepatologist with a special interest in colonic diseases including gastrointestinal infections and the gut microbiome. • Expertise in management of primary and recurrent Clostridioides difficile infection. • Evaluation of patients for microbiome-based therapies such as fecal microbiota transplantation. • Diagnosis and management of patients with undifferentiated gastrointestinal symptoms. • Passionate about educating patients to promote their understanding of their disease
- Dr. Khanna directs the Comprehensive Gastroenterology Interest group, C . difficile Clinic, Fecal Microbiota Transplantation program and C . difficile -related Clinical Trials at Mayo Clinic, Rochester, MN. He is the practice chair for the Inpatient Gastroenterology practice and the residents' rotation director for the Internal Medicine Residency Program at Mayo Clinic, Rochester, MN
- Glenn S. Tillotson, PhD, FIDSA, FCCP, is a Partner at GST Micro, and a consultant to the pharmaceutical and diagnostic industries, providing advice on a range of topics covering preparatory and postapproval activities. Glenn has over 30 years' pharmaceutical experience in clinical research, commercialization, and scientific communications including publications planning, strategic drug development, life cycle management, and global launch programs. After training in medical microbiology and infectious diseases in the UK, Glenn spent 13 years at Bayer AG in the UK, the United States, and Germany, where he was instrumental in the development of ciprofloxacin and moxifloxacin as well as other drugs
- James E. Lett, II, MD, CMD-R , is the Medical Director for Avar Consulting in Rockville, MD, and serves as President of the National Board for the National Transitions of Care Coalition (NTOCC) in Washington, DC. Dr Lett earned his medical degree from the University of Kentucky College of Medicine, where he completed residency training. He is board-certified in Family Medicine and Geriatrics
- Dr Lett has been part of the care transitions efforts for the American Medical Association (AMA), the American Medical Directors Association (AMDA), the Society for Hospital Medicine, and the Centers for Medicare & Medicaid Services (CMS). He is a past president of the American Medical Directors Association (AMDA). He served on a CMS workgroup to revise the survey manual for nursing homes. Dr Lett has chaired a joint national effort to develop a long-term care medication toolkit for patient safety. He also chaired a national workgroup that created guidelines for care transitions in the long-term care continuum. Dr Lett participates in a National Quality Forum measures workgroup
- Melanie A. Prince, MSS, MSN, BSN, NE-BC, CCM, FAAN, is the current President of Case Management Society of America (CMSA). She is a retired Active-Duty Military Colonel who was assigned to Headquarters Air Force where she was responsible for developing strategies to eliminate interpersonal violence in the military. Melanie is now the Chief Executive Officer, Care Associates Consulting. Melanie has been a requested speaker, including annual CMSA conferences, and penned case management content, editorials, policy, and training in various publications both military and nonmilitary. A distinguished leader and mentor in her profession, she has won numerous awards including the distinguished CMSA Chapter, 2003, and National Case Manager of the Year, 2004
- Cheri Lattimer, BSN, RN, is the Executive Director for the National Transitions of Care Coalition (NTOCC) and President of Integrity Advocacy & Management. Her leadership in quality improvement, case management, care coordination, and transitions of care is known on the national and international landscape. She was a contributor and reviewer for the Case Management Society of America (CMSA) Core Curriculum for Case Management and The Integrated Case Management Manual Assisting Complex Patients Regain Physical and Mental Health. She is affiliated with many professional organizations and maintains active roles on several national boards and committees including Chair of URAC's Health Standards Committee, CMS Caregiver Workgroup, CMS Advisory Panel on Education and Outreach, the American Board of Quality Assurance and Utilization Review Physicians (ABQAURP) Board of Directors and CME Committee and an Advisory Board Member for BelleCares
| | - James E Lett
- Rebecca Perez, MSN, RN, CCM, is an experienced RN with a master's degree in nursing, is a Certified Case Manager, and a member of the Gamma Omega Chapter of Sigma Theta Tau International Nursing Honor Society and Capella University National Society of Leadership and Success. She is the author of numerous professional articles, the primary author for the Case Management Adherence Guide 2020, co-author of CMSA's Integrated Case Management: A manual for case managers by case managers , developer of the Integrated Case Management Training Program, and Master Trainer. She joined Parthenon Management Group in 2020 as the Senior Manager of Education and Strategic Partnerships for the Case Management Society of America
- Sahil Khanna, MBBS, MS , is a gastroenterologist and hepatologist with a special interest in colonic diseases including gastrointestinal infections and the gut microbiome. • Expertise in management of primary and recurrent Clostridioides difficile infection. • Evaluation of patients for microbiome-based therapies such as fecal microbiota transplantation. • Diagnosis and management of patients with undifferentiated gastrointestinal symptoms. • Passionate about educating patients to promote their understanding of their disease
- Dr. Khanna directs the Comprehensive Gastroenterology Interest group, C . difficile Clinic, Fecal Microbiota Transplantation program and C . difficile -related Clinical Trials at Mayo Clinic, Rochester, MN. He is the practice chair for the Inpatient Gastroenterology practice and the residents' rotation director for the Internal Medicine Residency Program at Mayo Clinic, Rochester, MN
- Glenn S. Tillotson, PhD, FIDSA, FCCP, is a Partner at GST Micro, and a consultant to the pharmaceutical and diagnostic industries, providing advice on a range of topics covering preparatory and postapproval activities. Glenn has over 30 years' pharmaceutical experience in clinical research, commercialization, and scientific communications including publications planning, strategic drug development, life cycle management, and global launch programs. After training in medical microbiology and infectious diseases in the UK, Glenn spent 13 years at Bayer AG in the UK, the United States, and Germany, where he was instrumental in the development of ciprofloxacin and moxifloxacin as well as other drugs
- James E. Lett, II, MD, CMD-R , is the Medical Director for Avar Consulting in Rockville, MD, and serves as President of the National Board for the National Transitions of Care Coalition (NTOCC) in Washington, DC. Dr Lett earned his medical degree from the University of Kentucky College of Medicine, where he completed residency training. He is board-certified in Family Medicine and Geriatrics
- Dr Lett has been part of the care transitions efforts for the American Medical Association (AMA), the American Medical Directors Association (AMDA), the Society for Hospital Medicine, and the Centers for Medicare & Medicaid Services (CMS). He is a past president of the American Medical Directors Association (AMDA). He served on a CMS workgroup to revise the survey manual for nursing homes. Dr Lett has chaired a joint national effort to develop a long-term care medication toolkit for patient safety. He also chaired a national workgroup that created guidelines for care transitions in the long-term care continuum. Dr Lett participates in a National Quality Forum measures workgroup
- Melanie A. Prince, MSS, MSN, BSN, NE-BC, CCM, FAAN, is the current President of Case Management Society of America (CMSA). She is a retired Active-Duty Military Colonel who was assigned to Headquarters Air Force where she was responsible for developing strategies to eliminate interpersonal violence in the military. Melanie is now the Chief Executive Officer, Care Associates Consulting. Melanie has been a requested speaker, including annual CMSA conferences, and penned case management content, editorials, policy, and training in various publications both military and nonmilitary. A distinguished leader and mentor in her profession, she has won numerous awards including the distinguished CMSA Chapter, 2003, and National Case Manager of the Year, 2004
- Cheri Lattimer, BSN, RN, is the Executive Director for the National Transitions of Care Coalition (NTOCC) and President of Integrity Advocacy & Management. Her leadership in quality improvement, case management, care coordination, and transitions of care is known on the national and international landscape. She was a contributor and reviewer for the Case Management Society of America (CMSA) Core Curriculum for Case Management and The Integrated Case Management Manual Assisting Complex Patients Regain Physical and Mental Health. She is affiliated with many professional organizations and maintains active roles on several national boards and committees including Chair of URAC's Health Standards Committee, CMS Caregiver Workgroup, CMS Advisory Panel on Education and Outreach, the American Board of Quality Assurance and Utilization Review Physicians (ABQAURP) Board of Directors and CME Committee and an Advisory Board Member for BelleCares
| | - Melanie A Prince
- Rebecca Perez, MSN, RN, CCM, is an experienced RN with a master's degree in nursing, is a Certified Case Manager, and a member of the Gamma Omega Chapter of Sigma Theta Tau International Nursing Honor Society and Capella University National Society of Leadership and Success. She is the author of numerous professional articles, the primary author for the Case Management Adherence Guide 2020, co-author of CMSA's Integrated Case Management: A manual for case managers by case managers , developer of the Integrated Case Management Training Program, and Master Trainer. She joined Parthenon Management Group in 2020 as the Senior Manager of Education and Strategic Partnerships for the Case Management Society of America
- Sahil Khanna, MBBS, MS , is a gastroenterologist and hepatologist with a special interest in colonic diseases including gastrointestinal infections and the gut microbiome. • Expertise in management of primary and recurrent Clostridioides difficile infection. • Evaluation of patients for microbiome-based therapies such as fecal microbiota transplantation. • Diagnosis and management of patients with undifferentiated gastrointestinal symptoms. • Passionate about educating patients to promote their understanding of their disease
- Dr. Khanna directs the Comprehensive Gastroenterology Interest group, C . difficile Clinic, Fecal Microbiota Transplantation program and C . difficile -related Clinical Trials at Mayo Clinic, Rochester, MN. He is the practice chair for the Inpatient Gastroenterology practice and the residents' rotation director for the Internal Medicine Residency Program at Mayo Clinic, Rochester, MN
- Glenn S. Tillotson, PhD, FIDSA, FCCP, is a Partner at GST Micro, and a consultant to the pharmaceutical and diagnostic industries, providing advice on a range of topics covering preparatory and postapproval activities. Glenn has over 30 years' pharmaceutical experience in clinical research, commercialization, and scientific communications including publications planning, strategic drug development, life cycle management, and global launch programs. After training in medical microbiology and infectious diseases in the UK, Glenn spent 13 years at Bayer AG in the UK, the United States, and Germany, where he was instrumental in the development of ciprofloxacin and moxifloxacin as well as other drugs
- James E. Lett, II, MD, CMD-R , is the Medical Director for Avar Consulting in Rockville, MD, and serves as President of the National Board for the National Transitions of Care Coalition (NTOCC) in Washington, DC. Dr Lett earned his medical degree from the University of Kentucky College of Medicine, where he completed residency training. He is board-certified in Family Medicine and Geriatrics
- Dr Lett has been part of the care transitions efforts for the American Medical Association (AMA), the American Medical Directors Association (AMDA), the Society for Hospital Medicine, and the Centers for Medicare & Medicaid Services (CMS). He is a past president of the American Medical Directors Association (AMDA). He served on a CMS workgroup to revise the survey manual for nursing homes. Dr Lett has chaired a joint national effort to develop a long-term care medication toolkit for patient safety. He also chaired a national workgroup that created guidelines for care transitions in the long-term care continuum. Dr Lett participates in a National Quality Forum measures workgroup
- Melanie A. Prince, MSS, MSN, BSN, NE-BC, CCM, FAAN, is the current President of Case Management Society of America (CMSA). She is a retired Active-Duty Military Colonel who was assigned to Headquarters Air Force where she was responsible for developing strategies to eliminate interpersonal violence in the military. Melanie is now the Chief Executive Officer, Care Associates Consulting. Melanie has been a requested speaker, including annual CMSA conferences, and penned case management content, editorials, policy, and training in various publications both military and nonmilitary. A distinguished leader and mentor in her profession, she has won numerous awards including the distinguished CMSA Chapter, 2003, and National Case Manager of the Year, 2004
- Cheri Lattimer, BSN, RN, is the Executive Director for the National Transitions of Care Coalition (NTOCC) and President of Integrity Advocacy & Management. Her leadership in quality improvement, case management, care coordination, and transitions of care is known on the national and international landscape. She was a contributor and reviewer for the Case Management Society of America (CMSA) Core Curriculum for Case Management and The Integrated Case Management Manual Assisting Complex Patients Regain Physical and Mental Health. She is affiliated with many professional organizations and maintains active roles on several national boards and committees including Chair of URAC's Health Standards Committee, CMS Caregiver Workgroup, CMS Advisory Panel on Education and Outreach, the American Board of Quality Assurance and Utilization Review Physicians (ABQAURP) Board of Directors and CME Committee and an Advisory Board Member for BelleCares
| | - Cheri Lattimer
- Rebecca Perez, MSN, RN, CCM, is an experienced RN with a master's degree in nursing, is a Certified Case Manager, and a member of the Gamma Omega Chapter of Sigma Theta Tau International Nursing Honor Society and Capella University National Society of Leadership and Success. She is the author of numerous professional articles, the primary author for the Case Management Adherence Guide 2020, co-author of CMSA's Integrated Case Management: A manual for case managers by case managers , developer of the Integrated Case Management Training Program, and Master Trainer. She joined Parthenon Management Group in 2020 as the Senior Manager of Education and Strategic Partnerships for the Case Management Society of America
- Sahil Khanna, MBBS, MS , is a gastroenterologist and hepatologist with a special interest in colonic diseases including gastrointestinal infections and the gut microbiome. • Expertise in management of primary and recurrent Clostridioides difficile infection. • Evaluation of patients for microbiome-based therapies such as fecal microbiota transplantation. • Diagnosis and management of patients with undifferentiated gastrointestinal symptoms. • Passionate about educating patients to promote their understanding of their disease
- Dr. Khanna directs the Comprehensive Gastroenterology Interest group, C . difficile Clinic, Fecal Microbiota Transplantation program and C . difficile -related Clinical Trials at Mayo Clinic, Rochester, MN. He is the practice chair for the Inpatient Gastroenterology practice and the residents' rotation director for the Internal Medicine Residency Program at Mayo Clinic, Rochester, MN
- Glenn S. Tillotson, PhD, FIDSA, FCCP, is a Partner at GST Micro, and a consultant to the pharmaceutical and diagnostic industries, providing advice on a range of topics covering preparatory and postapproval activities. Glenn has over 30 years' pharmaceutical experience in clinical research, commercialization, and scientific communications including publications planning, strategic drug development, life cycle management, and global launch programs. After training in medical microbiology and infectious diseases in the UK, Glenn spent 13 years at Bayer AG in the UK, the United States, and Germany, where he was instrumental in the development of ciprofloxacin and moxifloxacin as well as other drugs
- James E. Lett, II, MD, CMD-R , is the Medical Director for Avar Consulting in Rockville, MD, and serves as President of the National Board for the National Transitions of Care Coalition (NTOCC) in Washington, DC. Dr Lett earned his medical degree from the University of Kentucky College of Medicine, where he completed residency training. He is board-certified in Family Medicine and Geriatrics
- Dr Lett has been part of the care transitions efforts for the American Medical Association (AMA), the American Medical Directors Association (AMDA), the Society for Hospital Medicine, and the Centers for Medicare & Medicaid Services (CMS). He is a past president of the American Medical Directors Association (AMDA). He served on a CMS workgroup to revise the survey manual for nursing homes. Dr Lett has chaired a joint national effort to develop a long-term care medication toolkit for patient safety. He also chaired a national workgroup that created guidelines for care transitions in the long-term care continuum. Dr Lett participates in a National Quality Forum measures workgroup
- Melanie A. Prince, MSS, MSN, BSN, NE-BC, CCM, FAAN, is the current President of Case Management Society of America (CMSA). She is a retired Active-Duty Military Colonel who was assigned to Headquarters Air Force where she was responsible for developing strategies to eliminate interpersonal violence in the military. Melanie is now the Chief Executive Officer, Care Associates Consulting. Melanie has been a requested speaker, including annual CMSA conferences, and penned case management content, editorials, policy, and training in various publications both military and nonmilitary. A distinguished leader and mentor in her profession, she has won numerous awards including the distinguished CMSA Chapter, 2003, and National Case Manager of the Year, 2004
- Cheri Lattimer, BSN, RN, is the Executive Director for the National Transitions of Care Coalition (NTOCC) and President of Integrity Advocacy & Management. Her leadership in quality improvement, case management, care coordination, and transitions of care is known on the national and international landscape. She was a contributor and reviewer for the Case Management Society of America (CMSA) Core Curriculum for Case Management and The Integrated Case Management Manual Assisting Complex Patients Regain Physical and Mental Health. She is affiliated with many professional organizations and maintains active roles on several national boards and committees including Chair of URAC's Health Standards Committee, CMS Caregiver Workgroup, CMS Advisory Panel on Education and Outreach, the American Board of Quality Assurance and Utilization Review Physicians (ABQAURP) Board of Directors and CME Committee and an Advisory Board Member for BelleCares
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17
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Hengel RL, Schroeder CP, Jo J, Ritter TE, Nathan RV, Gonzales-Luna AJ, Obi EN, Dillon RJ, Van Anglen LJ, Garey KW. Recurrent Clostridioides difficile infection worsens anxiety-related patient-reported quality of life. J Patient Rep Outcomes 2022; 6:49. [PMID: 35567724 PMCID: PMC9107550 DOI: 10.1186/s41687-022-00456-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Accepted: 04/29/2022] [Indexed: 12/03/2022] Open
Abstract
Background Clostridioides difficile infection (CDI) is associated with high recurrence rates impacting health-related quality of life (HrQOL). However, patient-reported data are lacking particularly in the outpatient setting. We assessed changes in HrQOL over time in patients treated with bezlotoxumab at US infusion centers and determined clinical factors associated with HrQOL changes. Methods The HrQOL survey was conducted in adult patients with CDI, who received bezlotoxumab in 25 US outpatient infusion centers. The survey was adapted from the Cdiff32 instrument to assess anxiety-related changes to HrQOL and completed on the day of infusion (baseline) and at 90 days post bezlotoxumab (follow-up). Demographics, disease history, CDI risk factors, and recurrence of CDI (rCDI) at 90-day follow-up were collected. Changes in HrQOL scores were calculated and outcomes assessed using a multivariable linear regression model with P < 0.05 defined as statistically significant. Results A total of 144 patients (mean age: 68 ± 15 years, 63% female, median Charlson index: 4, 15.9% rCDI) were included. The overall mean baseline and follow-up HrQOL scores were 26.4 ± 11.5 and 56.4 ± 25.0, respectively. At follow-up, this score was significantly higher for patients who had primary CDI (34.5 ± 21.7) compared to those with multiple rCDI (24.7 ± 21.0; P = 0.039). The mean HrQOL change at follow-up was significantly higher for patients without rCDI (34.1 ± 28.8 increase) compared to patients with rCDI (6.7 ± 19.5 increase; P < 0.001), indicating improvement in anxiety. Conclusions Using the Cdiff32 instrument, we demonstrated that HrQOL worsened significantly in patients with further rCDI. These findings support the use of Cdiff32 in assessing CDI-related humanistic outcomes.
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Affiliation(s)
- Richard L Hengel
- Atlanta ID Group, 275 Collier Rd, Suite 450, Atlanta, GA, 30309, USA.
| | - Claudia P Schroeder
- Healix Infusion Therapy, LLC, 14140 Southwest Freeway, Suite 400, Sugar Land, TX, 77478, USA
| | - Jinhee Jo
- University of Houston College of Pharmacy, 4800 Calhoun Rd, Houston, TX, 77004, USA
| | | | - Ramesh V Nathan
- Los Robles Health System, 215 W Janss Rd, Thousand Oaks, CA, 91360, USA
| | - Anne J Gonzales-Luna
- University of Houston College of Pharmacy, 4800 Calhoun Rd, Houston, TX, 77004, USA
| | - Engels N Obi
- Merck & Co., Inc, 2000 Galloping Hill Rd, Kenilworth, NJ, 07033, USA
| | - Ryan J Dillon
- Merck & Co., Inc, 2000 Galloping Hill Rd, Kenilworth, NJ, 07033, USA
| | - Lucinda J Van Anglen
- Healix Infusion Therapy, LLC, 14140 Southwest Freeway, Suite 400, Sugar Land, TX, 77478, USA
| | - Kevin W Garey
- University of Houston College of Pharmacy, 4800 Calhoun Rd, Houston, TX, 77004, USA
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18
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Jovanoski N, Kuznik A, Becker U, Hussein M, Briggs A. Cost-effectiveness of casirivimab/imdevimab in patients with COVID-19 in the ambulatory setting. J Manag Care Spec Pharm 2022; 28:555-565. [PMID: 35238626 DOI: 10.18553/jmcp.2022.21469] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND: Most patients infected with SARS-CoV-2, resulting in COVID-19, have only mild symptoms that can be managed in an ambulatory setting. However, a significant number of patients develop a more severe form of the disease and require hospital care, with the risk of long-term sequelae or death. Casirivimab/imdevimab is a combination of 2 recombinant human monoclonal antibodies that has been shown to significantly reduce the risk of hospitalization or death in patients with mild to moderate COVID-19 in the ambulatory setting. OBJECTIVE: To establish the cost-effectiveness of casirivimab/imdevimab in ambulatory individuals with COVID-19. METHODS: A cost-effectiveness model was constructed to simulate the natural history of COVID-19 in ambulatory patients and to identify those patients for whom casirivimab/imdevimab may be a cost-effective treatment from a US payer perspective. Patients enter the model in the ambulatory health state and can receive either active treatment with casirivimab/imdevimab or usual care. Patients can either recover from the infection or be hospitalized, from where they can recover from infection or die. Following this acute phase, patients enter a Markov model to estimate lifetime quality-adjusted life years. The model uses the risk of hospitalization in both the active treatment and usual care cohorts, and age- and sex-specific risk of mortality. Other model inputs include hospitalization costs and health-related utilities in the ambulatory acute treatment phase, the hospitalized setting, and the post-acute phase. Accounting for the heterogeneity of risk by age and comorbidities, results are presented separately for various combinations of baseline age and usual care risk in a 7 × 9 matrix. Outcomes related to "long COVID" are assessed in scenario analyses. RESULTS: In the base case, at a willingness-to-pay threshold of $100,000, treatment with casirivimab/imdevimab was found to be cost-effective in most patients, including those older than 40 years of age with a baseline hospitalization risk greater than or equal to 2% and patients aged 20 years with a baseline risk of hospitalization greater than or equal to 4%, whereas for hospitalization risk greater than or equal to 10%, casirivimab/imdevimab is dominant. Casirivimab/imdevimab was not cost-effective in patients aged 20 years with a 3% or lower risk of hospitalization or in patients aged 30 years with a 2% risk. CONCLUSIONS: This economic analysis found that casirivimab/imdevimab is a cost-effective treatment for most ambulatory patients with COVID-19. DISCLOSURES: N. Jovanoski and U. Becker are employees of F Hoffman-La Roche Ltd.; A. Kuznik and M. Hussein are employees of Regeneron Pharmaceuticals Inc. and hold stock and stock options; A. Briggs has provided consultancy to F Hoffman-La Roche Ltd. and has received consultancy fees from Merck and Co., Inc., GlaxoSmithKline plc., and Novartis. This study was funded by Regeneron Pharmaceuticals, Inc.
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Affiliation(s)
| | | | | | | | - Andrew Briggs
- London School of Hygiene & Tropical Medicine, London, UK
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19
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Hammeken LH, Baunwall SMD, Dahlerup JF, Hvas CL, Ehlers LH. Health-related quality of life in patients with recurrent Clostridioides difficile infections. Therap Adv Gastroenterol 2022; 15:17562848221078441. [PMID: 35463939 PMCID: PMC9019313 DOI: 10.1177/17562848221078441] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Accepted: 01/19/2022] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND The health-related quality of life (HrQoL) can be substantially affected in patients with recurrent Clostridioides difficile infection (rCDI) but the impact of effective treatment of the infection remains unclear. This study aimed to evaluate the HrQoL in patients with rCDI and estimate the gain in HrQoL associated with effective treatment of rCDI. METHODS Patients' HrQoL was estimated based on EuroQol 5-Dimensions 3-Levels (EQ-5D-3L) questionnaires obtained from a Danish randomised controlled trial (RCT). In the RCT, 64 patients with rCDI were randomised to receive either vancomycin (n = 16), fidaxomicin (n = 24) or faecal microbiota transplantation (FMT) preceded by vancomycin (n = 24). The primary outcome in the RCT was rCDI resolution. Patients were closely monitored during the RCT, and rescue FMT was offered to those who failed their primary treatment. Patients' HrQoL was measured at baseline and at 8- and 26-weeks follow-up. Linear regression analyses conditional on the differences between baseline and follow-up measurements were used to assess statistical significance (p < 0.05). RESULTS Within 26 weeks of follow-up, 13 (81%) patients treated with vancomycin, 12 (50%) patients treated with fidaxomicin, and 3 (13%) patients treated with FMT had a subsequent recurrence and received a rescue FMT. The average HrQoL for untreated patients with rCDI was 0.675. After receiving effective treatment, this value increased by 0.139 to 0.813 (p < 0.001) at week 8 and by 0.098 to 0.773 (p = 0.003) at week 26 of follow-up compared with baseline. CONCLUSION The HrQoL was adversely affected in patients with an active episode of rCDI but increased substantially after receiving an effective treatment algorithm in which rescue FMT was provided in case of a primary treatment failure. TRIAL REGISTRATION The RCT was preregistered at EudraCT (j.no. 2015-003004-24, https://www.clinicaltrialsregister.eu/ctr-search/trial/2015-003004-24/results) and at ClinicalTrials.gov (study identifier NCT02743234, https://clinicaltrials.gov/ct2/show/NCT02743234).
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Affiliation(s)
| | - Simon M. D. Baunwall
- Department of Hepatology and Gastroenterology, Aarhus University Hospital, Aarhus, Denmark
| | - Jens F. Dahlerup
- Department of Hepatology and Gastroenterology, Aarhus University Hospital, Aarhus, Denmark
| | - Christian L. Hvas
- Department of Hepatology and Gastroenterology, Aarhus University Hospital, Aarhus, Denmark
| | - Lars H. Ehlers
- Danish Center for Healthcare Improvements, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
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20
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Kohli MA, Maschio M, Lee A, Fust K, Van de Velde N, Buck PO, Weinstein MC. The potential clinical impact of implementing different COVID-19 boosters in fall 2022 in the United States. J Med Econ 2022; 25:1127-1139. [PMID: 36184797 DOI: 10.1080/13696998.2022.2126127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Emerging SARS-COV-2 variants are spurring the development of adapted vaccines as public health authorities plan for fall vaccinations. This study estimated the number of infections and hospitalizations prevented by three potential booster strategies for adults (≥18 years) in the United States: boosting with either Moderna's (1) licensed first generation monovalent vaccine mRNA-1273 (ancestral strain) or (2) candidate bivalent vaccine mRNA-1273.214 (ancestral + BA.1 variant of concern [VOC]) starting in September 2022, or (3) Moderna's updated candidate bivalent vaccine mRNA-1273.222 (ancestral + BA.4/5 VOC) starting November 2022 due to longer development time. METHODS An age-stratified, transmission dynamic, Susceptible-Exposed-Infection-Recovered (SEIR) model, adapted from previous literature, was used to estimate infections over time; the model contains compartments defined by SEIR and vaccination status. A decision tree was used to estimate clinical consequences of infections. Calibration was performed so the model tracks the actual course of the pandemic to present time. RESULTS Vaccinating with mRNA-1273(Sept), mRNA-1273.214(Sept), and mRNA-1273.222(Nov) is predicted to reduce infections by 34%, 40%, and 18%, respectively, and hospitalizations by 42%, 48%, and 25%, respectively, over 6 months compared to no booster. Sensitivity analyses around transmissibility, vaccine coverage, masking, and waning illustrate that boosting with mRNA-1273.214 in September prevented more cases of infection and hospitalization than the other vaccines. LIMITATIONS AND CONCLUSIONS With the emergence of new variants, key characteristics of the virus that affect estimates of spread and clinical impact also evolve, making parameter estimation difficult. Our analysis demonstrated that boosting with mRNA-1273.214 was more effective over 6 months in preventing infections and hospitalizations with a BA.4/5 subvariant than the tailored vaccine, simply because it could be deployed 2 months earlier. We conclude that there is no advantage to delay boosting until a more effective BA.4/5 vaccine is available; earlier boosting with mRNA-1273.214 will prevent the most infections and hospitalizations.
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Affiliation(s)
| | | | - Amy Lee
- Quadrant Health Economics Inc, Cambridge, Canada
| | - Kelly Fust
- Quadrant Health Economics Inc, Cambridge, Canada
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21
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Kelton K, Klein T, Murphy D, Belger M, Hille E, McCollam PL, Spiro T, Burge R. Cost-Effectiveness of Combination of Baricitinib and Remdesivir in Hospitalized Patients with COVID-19 in the United States: A Modelling Study. Adv Ther 2022; 39:562-582. [PMID: 34807369 PMCID: PMC8606629 DOI: 10.1007/s12325-021-01982-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 10/29/2021] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Baricitinib-remdesivir (BARI-REM) combination is superior to remdesivir (REM) in reducing recovery time and accelerating clinical improvement among hospitalized patients with coronavirus disease 2019 (COVID-19), specifically those receiving high-flow oxygen/noninvasive ventilation. Here we assessed the cost-effectiveness of BARI-REM versus REM in hospitalized patients with COVID-19 in the USA. METHODS A three-state model was developed addressing costs and patient utility associated with COVID-19 hospitalization, immediate post hospital care, and subsequent lifetime medical care. Analysis was performed from the perspective of a payer and a hospital. Both perspectives evaluated two subgroups: all patients and patients who required oxygen. The primary measures of benefit in the model were patient quality-adjusted life years (QALYs) accrued during and after hospitalization, cost per life years gained, cost per death avoided, and cost per use of mechanical ventilation avoided. RESULTS In the base-case payer perspective with a lifetime horizon, treatment with BARI-REM versus REM resulted in an incremental total cost of $7962, a gain of 0.446 life years and gain of 0.3565 QALYs over REM. The incremental cost-effectiveness ratios of using BARI-REM were estimated as $22,334 per QALY and $17,858 per life year. The base-case and sensitivity analyses showed that the total incremental cost per QALY falls within the reduced willingness-to-pay threshold of $50,000/QALY applied under health emergencies. In all hospitalized patients, treatment with BARI-REM versus REM reduced total hospital expenditures per patient by $1778 and total reimbursement payments by $1526, resulting in a $252 reduction in net costs per patient; it also resulted in a net gain of 0.0018 QALYs and increased survival of COVID-19 hospitalizations by 2.7%. CONCLUSION Our study showed that BARI-REM is cost-effective compared to using REM for hospitalized patients with COVID-19. The base-case results of this cost-effectiveness model were most sensitive to average annual medical costs for recovered patients.
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Affiliation(s)
- Kari Kelton
- Medical Decision Modeling Inc., Indianapolis, IN, USA
| | - Tim Klein
- Medical Decision Modeling Inc., Indianapolis, IN, USA
| | - Dan Murphy
- Medical Decision Modeling Inc., Indianapolis, IN, USA
| | - Mark Belger
- Eli Lilly and Company, 893 S. Delaware Street, Indianapolis, IN, 46225, USA
| | - Erik Hille
- Medical Decision Modeling Inc., Indianapolis, IN, USA
| | - Patrick L McCollam
- Eli Lilly and Company, 893 S. Delaware Street, Indianapolis, IN, 46225, USA
| | - Theodore Spiro
- Eli Lilly and Company, 893 S. Delaware Street, Indianapolis, IN, 46225, USA
| | - Russel Burge
- Eli Lilly and Company, 893 S. Delaware Street, Indianapolis, IN, 46225, USA.
- University of Cincinnati, Cincinnati, OH, USA.
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22
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Mponponsuo K, Leal J, Spackman E, Somayaji R, Gregson D, Rennert-May E. Mathematical model of the cost-effectiveness of the BioFire FilmArray Blood Culture Identification (BCID) Panel molecular rapid diagnostic test compared with conventional methods for identification of Escherichia coli bloodstream infections. J Antimicrob Chemother 2021; 77:507-516. [PMID: 34734238 DOI: 10.1093/jac/dkab398] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 10/05/2021] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Gram-negative pathogens, such as Escherichia coli, are common causes of bloodstream infections (BSIs) and increasingly demonstrate antimicrobial resistance. Molecular rapid diagnostic tests (mRDTs) offer faster pathogen identification and susceptibility results, but higher costs compared with conventional methods. We determined the cost-effectiveness of the BioFire FilmArray Blood Culture Identification (BCID) Panel, as a type of mRDT, compared with conventional methods in the identification of E. coli BSIs. METHODS We constructed a decision analytic model comparing BCID with conventional methods in the identification and susceptibility testing of hospitalized patients with E. coli BSIs from the perspective of the public healthcare payer. Model inputs were obtained from published literature. Cost-effectiveness was calculated by determining the per-patient admission cost, the QALYs garnered and the incremental cost-effectiveness ratios (ICERs) where applicable. Monte Carlo probabilistic sensitivity analyses and one-way sensitivity analyses were conducted to assess the robustness of the model. All costs reflect 2019 Canadian dollars. RESULTS The Monte Carlo probabilistic analyses resulted in cost savings ($27 070.83 versus $35 649.81) and improved QALYs (8.65 versus 7.10) in favour of BCID. At a willingness to pay up to $100 000, BCID had a 72.6%-83.8% chance of being cost-effective. One-way sensitivity analyses revealed length of stay and cost per day of hospitalization to have the most substantial impact on costs and QALYs. CONCLUSIONS BCID was found to be cost-saving when used to diagnose E. coli BSI compared with conventional testing. Cost savings were most influenced by length of stay and cost per day of hospitalization.
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Affiliation(s)
- Kwadwo Mponponsuo
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Jenine Leal
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada.,Department of Microbiology, Immunology and Infectious Diseases, University of Calgary, Alberta, Canada.,Infection Prevention and Control, Alberta Health Services, Calgary, Alberta, Canada.,O'Brien Institute for Public Health, University of Calgary and Alberta Health Services, Calgary, Alberta, Canada
| | - Eldon Spackman
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada.,O'Brien Institute for Public Health, University of Calgary and Alberta Health Services, Calgary, Alberta, Canada
| | - Ranjani Somayaji
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada.,Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada.,Department of Microbiology, Immunology and Infectious Diseases, University of Calgary, Alberta, Canada.,O'Brien Institute for Public Health, University of Calgary and Alberta Health Services, Calgary, Alberta, Canada.,Snyder Institute for Chronic Diseases, University of Calgary, Calgary, Alberta, Canada
| | - Daniel Gregson
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada.,Snyder Institute for Chronic Diseases, University of Calgary, Calgary, Alberta, Canada.,Department of Pathology & Laboratory Medicine, University of Calgary, Calgary, Alberta, Canada.,Alberta Precision Laboratories, University of Calgary, Calgary, Alberta, Canada
| | - Elissa Rennert-May
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada.,Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada.,Department of Microbiology, Immunology and Infectious Diseases, University of Calgary, Alberta, Canada.,O'Brien Institute for Public Health, University of Calgary and Alberta Health Services, Calgary, Alberta, Canada.,Snyder Institute for Chronic Diseases, University of Calgary, Calgary, Alberta, Canada
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Impact of Clostridioides difficile infection on patient-reported quality of life. Infect Control Hosp Epidemiol 2021; 43:1339-1344. [PMID: 34615561 DOI: 10.1017/ice.2021.413] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVE We investigated the quality of life (QoL) of patients hospitalized with C. difficile infection (CDI). DESIGN Prospective survey study. SETTING US tertiary-care referral center, acute-care setting. PARTICIPANTS Adults hospitalized with a diagnosis of CDI, defined as ≥3 episodes of unformed stool in 24 hours and a positive laboratory test for C. difficile. METHODS We surveyed patients from July 2019 to March 2020 using the disease-specific Cdiff32 questionnaire and the generic PROMIS GH survey. We compared differences in Cdiff32 scores among demographic and clinical subgroups (including CDI severity, CDI recurrence, and various comorbidities) using 2-sample t tests. We compared PROMIS GH scores to the general population T score of 50 using 1-sample t tests. We performed multivariable linear regression to identify predictors of Cdiff32 scores. RESULTS In total, 100 inpatients (mean age, 58.6 ±17.1 years; 53.0% male; 87.0% white) diagnosed with CDI completed QoL surveys. PROMIS GH physical health summary scores (T = 37.3; P < .001) and mental health summary scores (T = 43.4; P < .001) were significantly lower than those of the general population. In bivariate analysis, recurrent CDI, severe CDI, and number of stools were associated with lower Cdiff32 scores. In multivariable linear regression, recurrent CDI, severe CDI, and each additional stool in the previous 24 hours were associated with significantly decreased Cdiff32 scores. CONCLUSIONS Patients hospitalized with CDI reported low scores on the Cdiff32 and PROMIS GH, demonstrating a negative impact of CDI on QoL in multiple health domains. The Cdiff32 questionnaire is particularly sensitive to QoL changes in patients with recurrent or severe disease.
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Ohsfeldt R, Kelton K, Klein T, Belger M, Mc Collam PL, Spiro T, Burge R, Ahuja N. Cost-Effectiveness of Baricitinib Compared With Standard of Care: A Modeling Study in Hospitalized Patients With COVID-19 in the United States. Clin Ther 2021; 43:1877-1893.e4. [PMID: 34732289 PMCID: PMC8487786 DOI: 10.1016/j.clinthera.2021.09.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Revised: 09/17/2021] [Accepted: 09/20/2021] [Indexed: 12/15/2022]
Abstract
Purpose In the Phase III COV-BARRIER (Efficacy and Safety of Baricitinib for the Treatment of Hospitalised Adults With COVID-19) trial, treatment with baricitinib, an oral selective Janus kinase 1/2 inhibitor, in addition to standard of care (SOC), was associated with significantly reduced mortality over 28 days in hospitalized patients with coronavirus disease–2019 (COVID-19), with a safety profile similar to that of SOC alone. This study assessed the cost-effectiveness of baricitinib + SOC versus SOC alone (which included systemic corticosteroids and remdesivir) in hospitalized patients with COVID-19 in the United States. Methods An economic model was developed to simulate inpatients' stay, discharge to postacute care, and recovery. Costs modeled included payor costs, hospital costs, and indirect costs. Benefits modeled included life-years (LYs) gained, quality-adjusted life-years (QALYs) gained, deaths avoided, and use of mechanical ventilation avoided. The primary analysis was performed from a payor perspective over a lifetime horizon; a secondary analysis was performed from a hospital perspective. The base-case analysis modeled the numeric differences in treatment effectiveness observed in the COV-BARRIER trial. Scenario analyses were also performed in which the clinical benefit of baricitinib was limited to the statistically significant reduction in mortality demonstrated in the trial. Findings In the base-case payor perspective model, an incremental total cost of 17,276 US dollars (USD), total QALYs gained of 0.6703, and total LYs gained of 0.837 were found with baricitinib + SOC compared with SOC alone. With the addition of baricitinib, survival was increased by 5.1% and the use of mechanical ventilation was reduced by 1.6%. The base-case incremental cost-effectiveness ratios were 25,774 USD/QALY gained and 20,638 USD/LY gained; a “mortality-only” scenario analysis yielded similar results of 26,862 USD/QALY gained and 21,433 USD/LY gained. From the hospital perspective, combination treatment with baricitinib + SOC was more effective and less costly than was SOC alone in the base case, with an incremental cost of 38,964 USD per death avoided in the mortality-only scenario. Implications In hospitalized patients with COVID-19 in the United States, the addition of baricitinib to SOC was cost-effective. Cost-effectiveness was demonstrated from both the payor and the hospital perspectives. These findings were robust to sensitivity analysis and to conservative assumptions limiting the clinical benefits of baricitinib to the statistically significant reduction in mortality demonstrated in the COV-BARRIER trial.
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Affiliation(s)
- Robert Ohsfeldt
- Texas A&M University, College Station, Texas; Medical Decision Modeling Inc, Indianapolis, Indiana
| | - Kari Kelton
- Medical Decision Modeling Inc, Indianapolis, Indiana
| | - Tim Klein
- Medical Decision Modeling Inc, Indianapolis, Indiana
| | - Mark Belger
- Eli Lilly and Company, Indianapolis, Indiana
| | | | | | - Russel Burge
- Eli Lilly and Company, Indianapolis, Indiana; University of Cincinnati, Cincinnati, Ohio.
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25
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Guery B, Berger P, Gauzit R, Gourdon M, Barbut F, Dafne Study Group, Bémer P, Bessède E, Camou F, Cattoir V, Couzigou C, Descamps D, Dinh A, Laurans C, Lavigne JP, Lechiche C, Leflon-Guibout V, Le Monnier A, Levast M, Mootien JY, N'Guyen Y, Piroth L, Prazuck T, Rogeaux O, Roux AL, Vachée A, Vernet Garnier V, Wallet F. A prospective, observational study of fidaxomicin use for Clostridioides difficile infection in France. J Int Med Res 2021; 49:3000605211021278. [PMID: 34162264 PMCID: PMC8236878 DOI: 10.1177/03000605211021278] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVE To describe the characteristics, management and outcomes of hospitalised patients with Clostridioides difficile infection (CDI) treated with and without fidaxomicin. METHODS This prospective, multicentre, observational study (DAFNE) enrolled hospitalised patients with CDI, including 294 patients treated with fidaxomicin (outcomes recorded over a 3-month period) and 150 patients treated with other CDI therapies during three 1-month periods. The primary endpoint was baseline and CDI characteristics of fidaxomicin-treated patients. RESULTS At baseline, the fidaxomicin-treated population included immunocompromised patients (39.1%) and patients with severe (59.2%) and recurrent (36.4%) CDI. Fidaxomicin was associated with a high rate of clinical cure (92.2%) and low CDI recurrence (16.3% within 3 months). Clinical cure rates were ≥90% in patients aged ≥65 years, those receiving concomitant antibiotics and those with prior or severe CDI. There were 121/296 (40.9%) patients with adverse events (AEs), 5.4% with fidaxomicin-related AEs and 1.0% with serious fidaxomicin-related AEs. No fidaxomicin-related deaths were reported. CONCLUSIONS Fidaxomicin is an effective and well-tolerated CDI treatment in a real-world setting in France, which included patients at high risk of adverse outcomes.Trial registration: Description of the use of fidaxomicin in hospitalised patients with documented Clostridium difficile infection and the management of these patients (DAFNE), NCT02214771, www.ClinicalTrials.gov.
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Affiliation(s)
- Benoit Guery
- University Hospital and University of Lausanne, Lausanne, Switzerland
| | | | | | | | - Frédéric Barbut
- National Reference Laboratory for C. difficile, Saint-Antoine Hospital, Paris, France.,INSERM S-1139, Faculty of Pharmacy, University of Paris, Paris, France
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26
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Basu A, Gandhay VJ. Quality-Adjusted Life-Year Losses Averted With Every COVID-19 Infection Prevented in the United States. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2021; 24:632-640. [PMID: 33933231 PMCID: PMC7938736 DOI: 10.1016/j.jval.2020.11.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 11/02/2020] [Accepted: 11/20/2020] [Indexed: 05/08/2023]
Abstract
OBJECTIVE To estimate the overall quality-adjusted life-years (QALYs) gained by averting 1 coronavirus disease 2019 (COVID-19) infection over the duration of the pandemic. METHODS A cohort-based probabilistic simulation model, informed by the latest epidemiological estimates on COVID-19 in the United States provided by the Centers for Disease Control and Prevention and literature review. Heterogeneity of parameter values across age group was accounted for. The main outcome studied was QALYs for the infected patient, patient's family members, and the contagion effect of the infected patient over the duration of the pandemic. RESULTS Averting a COVID-19 infection in a representative US resident will generate an additional 0.061 (0.016-0.129) QALYs (for the patient: 0.055, 95% confidence interval [CI] 0.014-0.115; for the patient's family members: 0.006, 95% CI 0.002-0.015). Accounting for the contagion effect of this infection, and assuming that an effective vaccine will be available in 3 months, the total QALYs gains from averting 1 single infection is 1.51 (95% CI 0.28-4.37) accrued to patients and their family members affected by the index infection and its sequelae. These results were robust to most parameter values and were most influenced by effective reproduction number, probability of death outside the hospital, the time-varying hazard rates of hospitalization, and death in critical care. CONCLUSION Our findings suggest that the health benefits of averting 1 COVID-19 infection in the United States are substantial. Efforts to curb infections must weigh the costs against these benefits.
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Affiliation(s)
- Anirban Basu
- The CHOICE Institute, School of Pharmacy, University of Washington, Seattle, WA, USA.
| | - Varun J Gandhay
- Department of Economics, University of California, San Diego, CA, USA
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27
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Hammeken LH, Baunwall SMD, Hvas CL, Ehlers LH. Health economic evaluations comparing faecal microbiota transplantation with antibiotics for treatment of recurrent Clostridioides difficile infection: a systematic review. HEALTH ECONOMICS REVIEW 2021; 11:3. [PMID: 33439367 PMCID: PMC7805077 DOI: 10.1186/s13561-021-00301-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 01/04/2021] [Indexed: 05/10/2023]
Abstract
BACKGROUND Faecal microbiota transplantation (FMT) is increasingly being used in the treatment of recurrent Clostridioides difficile infection (rCDI). Health economic evaluations may support decision-making regarding the implementation of FMT in clinical practice. Previous reviews have highlighted several methodological concerns in published health economic evaluations examining FMT. However, the impact of these concerns on the conclusions of the studies remains unclear. AIMS To present an overview and assess the methodological quality of health economic evaluations that compare FMT with antibiotics for treatment of rCDI. Furthermore, we aimed to evaluate the degree to which any methodological concerns would affect conclusions about the cost-effectiveness of FMT. METHODS We conducted a systematic literature review based on a search in seven medical databases up to 16 July 2020. We included research articles reporting on full health economic evaluations comparing FMT with antibiotic treatment for rCDI. General study characteristics and input estimates for costs, effectiveness and utilities were extracted from the articles. The quality of the studies was assessed by two authors using the Drummonds ten-point checklist. RESULTS We identified seven cost-utility analyses. All studies applied decision-analytic modelling and compared various FMT delivery methods with vancomycin, fidaxomicin, metronidazole or a combination of vancomycin and bezlotoxumab. The time horizons used in the analyses varied from 78 days to lifelong, and the perspectives differed between a societal, a healthcare system or a third-party payer perspective. The applied willingness-to-pay threshold ranged from 20,000 to 68,000 Great Britain pound sterling (GBP) per quality-adjusted life-year (QALY). FMT was considered the most cost-effective alternative in all studies. In five of the health economic evaluations, FMT was both more effective and cost saving than antibiotic treatment alternatives. The quality of the articles varied, and we identified several methodological concerns. CONCLUSIONS Economic evaluations consistently reported that FMT is a cost-effective and potentially cost-saving treatment for rCDI. Based on a comparison with recent evidence within the area, the multiple methodological concerns seem not to change this conclusion. Therefore, implementing FMT for rCDI in clinical practice should be strongly considered.
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Affiliation(s)
- Lianna Hede Hammeken
- Danish Center for Healthcare Improvements, Department of Clinical Medicine, Aalborg University, Fredrik Bajers Vej 5, DK-9220 Aalborg Ø, Denmark
| | - Simon Mark Dahl Baunwall
- Department of Hepatology and Gastroenterology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, DK-8200 Aarhus, Denmark
| | - Christian Lodberg Hvas
- Department of Hepatology and Gastroenterology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, DK-8200 Aarhus, Denmark
| | - Lars Holger Ehlers
- Danish Center for Healthcare Improvements, Department of Clinical Medicine, Aalborg University, Fredrik Bajers Vej 5, DK-9220 Aalborg Ø, Denmark
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28
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Lurienne L, Bandinelli PA, Galvain T, Coursel CA, Oneto C, Feuerstadt P. Perception of quality of life in people experiencing or having experienced a Clostridioides difficile infection: a US population survey. J Patient Rep Outcomes 2020; 4:14. [PMID: 32076853 PMCID: PMC7031450 DOI: 10.1186/s41687-020-0179-1] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Accepted: 02/11/2020] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Although the incidence, severity and mortality of Clostridioides (Clostridium) difficile infection (CDI) have been increasing, patients' quality of life changes resulting from CDI have not been studied thoroughly. This study aimed at exploring the consequences of CDI on quality of life through patients' perspective. METHODS An observational, cross-sectional study involving 350 participants with a self-reported CDI diagnosis was conducted through an online self-administered survey. Participants were grouped into those who had active disease ("Current CDI") and those who had a history of CDI ("Past CDI"). RESULTS One hundred fifteen participants (33%) reported Current CDI and 235 (67%) reported Past CDI. A large majority of participants admitted that their daily activities were impacted by the infection (93.9% and 64.7% of Current and Past CDI respondents respectively, p < 0.05). Physical and psychological consequences of CDI were experienced by 63.5% and 66.1% of participants with active CDI. Despite the infection being cleared, these consequences were still frequently experienced in Past CDI cohort with similar rates (reported by 73.2% of respondents for both, physical consequences p = 0.08; psychological consequences p = 0.21). After the infection, 56.6% of respondents noted that post-CDI symptoms remained; 40.9% believed they would never get rid of them. CONCLUSIONS While the societal burden of CDI is well described in the literature, our study is one of the first aimed at understanding the major burden of CDI on quality of life. Our results highlight the long-lasting nature of CDI and further reinforce the need for enhanced therapeutics in the prevention and treatment of this devastating infection.
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Affiliation(s)
- Lise Lurienne
- Da Volterra, 172 rue de Charonne, 75011, Paris, France.
| | | | | | | | | | - Paul Feuerstadt
- Yale School of Medicine, New Haven, CT, USA
- Gastroenterology Center of Connecticut, Hamden, CT, USA
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Stewart S, Robertson C, Manoukian S, Haahr L, Mason H, McFarland A, Dancer S, Cook B, Reilly J, Graves N. How do we evaluate the cost of nosocomial infection? The ECONI protocol: an incidence study with nested case-control evaluating cost and quality of life. BMJ Open 2019; 9:e026687. [PMID: 31221878 PMCID: PMC6588979 DOI: 10.1136/bmjopen-2018-026687] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Revised: 04/08/2019] [Accepted: 05/08/2019] [Indexed: 11/11/2022] Open
Abstract
INTRODUCTION Healthcare-associated or nosocomial infection (HAI) is distressing to patients and costly for the National Health Service (NHS). With increasing pressure to demonstrate cost-effectiveness of interventions to control HAI and notwithstanding the risk from antimicrobial-resistant infections, there is a need to understand the incidence rates of HAI and costs incurred by the health system and for patients themselves. METHODS AND ANALYSIS The Evaluation of Cost of Nosocomial Infection study (ECONI) is an observational incidence survey with record linkage and a nested case-control study that will include postdischarge longitudinal follow-up and qualitative interviews. ECONI will be conducted in one large teaching hospital and one district general hospital in NHS Scotland. The case mix of these hospitals reflects the majority of overnight admissions within Scotland. An incidence survey will record all HAI cases using standard case definitions. Subsequent linkage to routine data sets will provide information on an admission cohort which will be grouped into HAI and non-HAI cases. The case-control study will recruit eligible patients who develop HAI and twice that number without HAI as controls. Patients will be asked to complete five questionnaires: the first during their stay, and four others during the year following discharge from their recruitment admission (1, 3, 6 and 12 months). Multiple data collection methods will include clinical case note review; patient-reported outcome; linkage to electronic health records and qualitative interviews. Outcomes collected encompass infection types; morbidity and mortality; length of stay; quality of life; healthcare utilisation; repeat admissions and postdischarge prescribing. ETHICS AND DISSEMINATION The study has received a favourable ethical opinion from the Scotland A Research Ethics Committee (reference 16/SS/0199). All publications arising from this study will be published in open-access peer-reviewed journal. Lay-person summaries will be published on the ECONI website. TRIAL REGISTRATION NUMBER NCT03253640; Pre-results.
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Affiliation(s)
- Sally Stewart
- Safeguarding Health through Infection Prevention Research Group, Centre for Living, Glasgow Caledonian University, Glasgow, UK
| | - Chris Robertson
- Department of Mathematics and Statistics, University of Strathclyde, Glasgow, UK
| | - Sarkis Manoukian
- Yunus Centre for Social Business and Health, Glasgow Caledonian University, Glasgow, UK
| | - Lynne Haahr
- Safeguarding Health through Infection Prevention Research Group, Centre for Living, Glasgow Caledonian University, Glasgow, UK
| | - Helen Mason
- Yunus Centre for Social Business and Health, Glasgow Caledonian University, Glasgow, UK
| | - Agi McFarland
- Safeguarding Health through Infection Prevention Research Group, Centre for Living, Glasgow Caledonian University, Glasgow, UK
| | - Stephanie Dancer
- Department of Microbiology, Hairmyres Hospital, NHS Lanarkshire, Scotland, UK
| | - Brian Cook
- University Hospitals & Support Services, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Jacqui Reilly
- Safeguarding Health through Infection Prevention Research Group, Centre for Living, Glasgow Caledonian University, Glasgow, UK
| | - Nicholas Graves
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
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