Cost-effectiveness of Commercial or Traditional Fecal Microbiota Transplantation for Recurrent Clostridioides difficile Infection
Colonoscopy-delivered FMT is the dominant cost-effective strategy for rCDI; FDA-approved commercial microbiota therapeutics were not cost-effective under any modeled circumstance when donor-derived FMT is available.
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What the study showed
A Markov model estimated an ICER of $44,158 per QALY for colonoscopy-delivered FMT, which was optimal in 70% of simulations at a $100,000/QALY willingness-to-pay threshold. Commercial FDA-approved microbiota products did not achieve cost-effectiveness under any simulated scenario when traditional FMT was available. The study relies on externally sourced efficacy data rather than primary clinical outcomes.
How it was done
Markov model simulating a cohort of rCDI patients, using cure, recurrence, and mortality estimates from national guidelines and published literature. Primary outcomes were QALYs and ICERs.
Risk of bias
Economic modeling study — generates no primary clinical evidence. Model parameters depend on third-party published data subject to variability and potential selection bias; real-world availability of colonoscopy-based FMT differs across health systems.
What this study does NOT prove
The study does not demonstrate clinical superiority of traditional FMT over commercial products, only an economic advantage within the model's assumptions.
In clinical practice
Where colonoscopy-delivered FMT is accessible, this analysis supports its economic preference over commercial products. Clinical decisions must also weigh local availability, infrastructure, and patient-specific factors.
Limitations
Economic modeling study — generates no primary clinical evidence. Model parameters depend on third-party published data subject to variability and potential selection bias; real-world availability of colonoscopy-based FMT differs across health systems.
Technical appendix
Version history
- 1.0 · 2026-07-23 — Auto-generated under Evidence Standard v1.0
Paid access: structured summary from public metadata; consult the original study at the source.