Cost-effectiveness analysis of fecal microbiota transplantation for inflammatory bowel disease

Abstract

// <![CDATA[ $('.header-date').hide();$('#titleAuthors').hide();$('#abstractHeader').hide(); // ]]> Ting Zhang1, *, Jie Xiang1, *, Bota Cui1, Zhi He1, Pan Li1, Hai Chen2, Lijuan Xu1, Guozhong Ji1, Yongzhan Nie3, Kaichun Wu3, Daiming Fan3, Guangming Huang1, **, Jianling Bai4, ** and Faming Zhang1, ** 1Medical Center for Digestive Diseases, The Second Affiliated Hospital of Nanjing Medical University, Nanjing 210011, China 2Center for Disease Control and Prevention, Wuxi 214000, China 3State Key Laboratory of Cancer Biology and Xijing Hospital of Digestive Diseases, The Fourth Military Medical University, Xi’an 710032, China 4Department of Biostatistics, School of Public Health, Nanjing Medical University, Nanjing 211100, China *These authors have contributed equally to this work **Co-responding authors contributed equally Correspondence to: Faming Zhang, email: fzhang@njmu.edu.cn Jianling Bai, email: jbai@njmu.edu.cn Guangming Huang, email: hgming@njmu.edu.cn Keywords: inflammatory bowel disease, fecal microbiota transplantation, cost-effectiveness analysis, incremental cost effectiveness ratio, net monetary benefit Received: July 05, 2017 Accepted: August 08, 2017 Published: October 04, 2017 ABSTRACT There is a lack of health economics evidence on the use of fecal microbiota transplantation (FMT) for inflammatory bowel disease (IBD). This study aims to evaluate the cost-effectiveness before (with conventional therapy) and after introducing FMT for treating IBD. 104 patients with IBD received FMT were recruited. Health status was evaluated by European dimension health table (ED-5Q). Incremental cost-effectiveness ratio (ICER) and net monetary benefit (NB) were calculated by different age groups, genders, smoking status, and disease subtypes. The willingness-to-pay threshold was set to the value equal to three times China’s per capita GDP (141240 CNY/QALY, 2014). From the health-care perspective, FMT strategy was 73% likely to be cost-effective compared with the conventional therapy before FMT with an ICER of -185712 CNY/QALY and a positive NB of CNY 45150. From the societal perspective, FMT strategy was 75% likely to be cost-effective with an ICER of -207417 CNY/QALY and a positive NB of CNY 48395. Moreover, younger patients (≤ 24), females, non-smokers and Crohn’s disease (CD) achieved more benefits. This study for the first time demonstrated that FMT showed its cost-effectiveness, especially on improving the life quality and decreasing the medical and societal cost, for the moderate to severe IBD in a Chinese cohort.