Original Title: Trasplante de microbiota fecal en infección recurrente por Clostridioides difficile

Authors' recommendations: Moderate-quality evidence shows that heterologous fecal microbiota transplantation is likely to decrease the risk of recurrence in patients with recurrent Clostridioides difficile (C. difficile) infection when compared with vancomycin and fidaxomicin. Also, the benefits of multiple transplantations are better than a single transplantation. Moderate-quality evidence shows that lower endoscopic administration is better than upper endoscopic administration, capsules and enema as a single infusions. In cases of multiple transplantations, low-quality evidence suggests that lower endoscopic administration is better than the other available routes. Moderate-quality evidence shows that heterologous fecal microbiota transplantation is probably better than autologous transplantation to achieve symptom resolution with no need of further treatments. Moderate-quality evidence shows that fecal microbiota transplantation is probably a safe practice for recurrent C. difficile infection. The clinical practice guidelines from United States, Canada, United Kingdom and Europe recommend fecal microbiota transplantation as from the second C. difficile infection recurrence. In the British Society of Gastroenterology guideline, the indication is considered as from the first episode of recurrence, but in patients with risk factors, it is indicated for new episodes or severe or complicated infection. No health technology or economic evaluations were found in Argentina on fecal microbiota transplantation for recurrent C. difficile infection. The economic evaluations from United States, Canada, France, Australia and China determined that fecal microbiota transplantation was cost-effective when compared with vancomycin and fidaxomicin for the payment threshold estimated by these health systems and also, it might be higher if the indication were restricted to second or further recurrences. In United States, the public sector does not cover this technology, whereas the private funder, Aetna, covers it after the first recurrence, similar to the United Kingdom national health system. No information was found about fecal microbiota transplantation for this indication in the health funders consulted from Latin-America, including Argentina. Given the cost ratio between fecal microbiota transplantation and vancomycin capsules in the Argentine market, a single infusion might be cost-saving when compared with a 14-day vancomycin therapy. When multiple transplantations are needed, or if they occur in a short period of time or when compared with long-term vancomycin (tapering) therapy, cost- effectiveness is uncertain.

Project Status: Completed

Year Published: 2022

URL for published report: https://www.iecs.org.ar/publicacion/?id=21886

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: Argentina

Organisation Name: Institute for Clinical Effectiveness and Health Policy

Contact Address: Dr. Emilio Ravignani 2024, Buenos Aires - Argentina, C1414 CABA

Contact Name: info@iecs.org.ar

Contact Email: info@iecs.org.ar

Copyright: Institute for Clinical Effectiveness and Health Policy (IECS)