{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,2]],"date-time":"2026-10-02T13:33:21Z","timestamp":1790948001399,"version":"4.1.0"},"reference-count":33,"publisher":"Oxford University Press (OUP)","issue":"1","license":[{"start":{"date-parts":[[2023,1,7]],"date-time":"2023-01-07T00:00:00Z","timestamp":1673049600000},"content-version":"vor","delay-in-days":9,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2022,12,29]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Importance<\/jats:title>\n                    <jats:p>Recent changes in guidelines for managing Clostridioides difficile infections (CDI) have placed fidaxomicin as a first-line treatment.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To estimate the net cost of first-line fidaxomicin compared to vancomycin in the American and Canadian healthcare systems and to estimate the price points at which fidaxomicin would become cost saving for the prevention of recurrence.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Data sources and study selection<\/jats:title>\n                    <jats:p>We identified randomized, placebo-controlled trials directly comparing fidaxomicin with vancomycin that reported on recurrence. Medication costs were obtained from the Veterans Affairs Federal Supply Schedule (US) and the Quebec drug formulary (Canada). The average cost of a CDI recurrence was established through a systematic review for each country.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Data extraction, synthesis and outcome measures<\/jats:title>\n                    <jats:p>For efficacy, data on CDI recurrence at day 40 were pooled using a restricted maximal likelihood random effects model. For the cost review, the mean cost across identified studies was adjusted to reflect May 2022 dollars. These were used to estimate the net cost per recurrence prevented with fidaxomicin and the price point below which fidaxomicin would be cost saving.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The estimated mean system costs of a CDI recurrence were $15\u200a147USD and $8806CAD, respectively. Preventing one recurrence by using first-line fidaxomicin over vancomycin would cost $38\u200a222USD (95%CI $30 577\u2013$57\u200a332) and $13\u200a760CAD (95%CI $11\u200a008\u2013$20\u200a640), respectively. The probability that fidaxomicin was cost saving exceeded 95% if priced below $1140USD or $860CAD, respectively.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions and Relevance<\/jats:title>\n                    <jats:p>An increased drug expenditure on fidaxomicin may not be offset through recurrence prevention unless the fidaxomicin price is negotiated.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/jacamr\/dlac138","type":"journal-article","created":{"date-parts":[[2022,12,13]],"date-time":"2022-12-13T17:45:01Z","timestamp":1670953501000},"source":"Crossref","is-referenced-by-count":23,"title":["Fidaxomicin to prevent recurrent\n                    <i>Clostridioides difficile<\/i>\n                    : what will it cost in the USA and Canada?"],"prefix":"10.1093","volume":"5","author":[{"given":"Devangi","family":"Patel","sequence":"first","affiliation":[{"name":"Faculty of Medicine and Health Sciences, McGill University , Montr\u00e9al , Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julien","family":"Senecal","sequence":"additional","affiliation":[{"name":"Faculty of Medicine and Health Sciences, McGill University , Montr\u00e9al , Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brad","family":"Spellberg","sequence":"additional","affiliation":[{"name":"Los Angeles County and University of Southern California Medical Center , Los Angeles, CA , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew M","family":"Morris","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases, Department of Medicine, Sinai Health, University Health Network, and University of Toronto , Toronto , Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4133-9337","authenticated-orcid":false,"given":"Lynora","family":"Saxinger","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases, Department of Medicine, University of Alberta , Edmonton , Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brent W","family":"Footer","sequence":"additional","affiliation":[{"name":"Providence Portland Medical Center , Portland , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0783-0624","authenticated-orcid":false,"given":"Emily G","family":"McDonald","sequence":"additional","affiliation":[{"name":"Division of General Internal Medicine, Department of Medicine, McGill University Health Centre , Montr\u00e9al , Canada"},{"name":"Clinical Practice Assessment Unit, Department of Medicine, McGill University Health Centre , Montr\u00e9al , Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2267-4239","authenticated-orcid":false,"given":"Todd C","family":"Lee","sequence":"additional","affiliation":[{"name":"Division of General Internal Medicine, Department of Medicine, McGill University Health Centre , Montr\u00e9al , Canada"},{"name":"Clinical Practice Assessment Unit, Department of Medicine, McGill University Health Centre , Montr\u00e9al , Canada"},{"name":"Division of Infectious Diseases, Department of Medicine, McGill University Health Centre , Montr\u00e9al , Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2023,1,7]]},"reference":[{"key":"2023010808140767200_dlac138-B1","doi-asserted-by":"crossref","first-page":"1320","DOI":"10.1056\/NEJMoa1910215","article-title":"Trends in U.S. burden of Clostridioides difficile infection and outcomes","volume":"382","author":"Guh","year":"2020","journal-title":"N 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adults and children: 2017 update by the Infectious Diseases Society of America (IDSA) and Society for Healthcare Epidemiology of America (SHEA)","volume":"66","author":"McDonald","year":"2018","journal-title":"Clin Infect Dis"},{"key":"2023010808140767200_dlac138-B8","first-page":"71","article-title":"Association of Medical Microbiology and Infectious Disease Canada treatment practice guidelines for Clostridium difficile infection","volume":"3","author":"Loo","year":"2018","journal-title":"J Assoc Med Microbiol Infect Dis Canada"},{"key":"2023010808140767200_dlac138-B9","doi-asserted-by":"crossref","first-page":"e1029","DOI":"10.1093\/cid\/ciab549","article-title":"Clinical practice guideline by the Infectious Diseases Society of America (IDSA) and Society for Healthcare Epidemiology of America (SHEA): 2021 focused update guidelines on management of Clostridioides difficile infection in adults","volume":"73","author":"Johnson","year":"2021","journal-title":"Clin Infect 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