Fecal Microbiota Transplantation: Effective Treatment With Economic Benefits

Healthy donor feces is a life-saving therapy, and the treatment provides huge cost savings -- fecal microbiota transplantation (FMT) saves at least $1.2 million each time 50 patients are treated for Clostridium difficile at a public hospital. These are the perspectives of the first observational study in the world to detail the process for the 50 patients who received FMY for Clostridium difficile colitis in 2014 and 2015 as an alternative to antibiotics.

"Our study shows that on average the patients each avoided 17 days in hospital the first year after their fecal microbiota transplantation. They went from being hospitalized 37 days a year to 20 days a year in average, following the transplantation," says Christian Lodberg Hvas, a consultant at the Department of Hepatology and Gastroenterology at Aarhus University Hospital and a clinical associate professor at the Department of Clinical Medicine at Aarhus University. He is also the last author on the study which has just been published in the scientific journal Therapeutic Advances in Gastroenterology.

The study concludes that the total hospital costs per patient were 42 percent lower and that the average cost decreased from $63,300 to $36,800 per year. The average amount covers large individual differences that influence the bottom line because some of the patients were so ill that they ended up being moved in and out of intensive care, where a bed costs up to $5,300 a day. The cost of an ordinary hospital bed is approx. $1,200 per day depending on how it is calculated.

"The $26,500 that we save with each patient each year is calculated based on the costs of hospitalization, antibiotics and the fecal microbiota transplantation. Although a huge annual saving, it is a very conservative estimate. We only included hospital costs, and because half of the patients were below 60 years of age, factors such as loss of earnings should also be counted in," says Hvas.

It is the first time a scientific study has been published based on real world data that describe the costs of fecal microbial transplantation compared to the alternative, which is treatment with antibiotics using products such as vancomycin and fidaxomicin.

"There are other studies that make theoretical calculations about what the different types of treatment cost society, but this is the first time anyone has made calculations based on the patients' actual medical history -- with costs and derived hospital savings calculated one year before and one year after fecal microbiota transplantation," Hvas says.

In the study, the Department of Hepatology and Gastroenterology provided data in the form of patient medical records for all 50 patients who received FMT at Aarhus University Hospital during 2014 and 2015.

All of the medical records and documents were reviewed at the Department of Business and Management at Aalborg University, with health economist and professor Lars Holger Ehlers overseeing the process. The results were subjected to a sensitivity analysis to prevent any over-interpretation of the results.

"As an example, we take into account that these patients have already contracted Clostridium difficile in connection with another illness -- and this is what characterises the bacteria -- and that they spend many days in hospital for this reason alone. So we can be certain that the large difference in hospital costs is due to the Clostridium difficile disease itself and the subsequent faeces transplantation and not other diseases. This is where we use the sensitivity analysis and test different scenarios," Ehlers explains.

Ehlers collaborates with Hvas at the Centre for Fecal Microbiota Transplantation at Aarhus University Hospital, which also includes professor Tine Rask Licht from the Technical University of Denmark and consultant and professor Christian Erikstrup from the Blood Bank and Immunology at Aarhus University Hospital.

CEFTA works with the support of the Innovation Fund Denmark to turn faeces from healthy, registered and thoroughly tested donors into a standard treatment for the persistent bacteria which is today regarded as one of the most dangerous bacteria to humans. To do this, a feces bank is being created in Aarhus according to the principles of the blood bank.

"Fecal microbiota transplantation is a new and extremely effective treatment. The introduction of new treatments is usually very expensive, but here we have a form of treatment that on top of everything also saves society millions of Euro every month. If we can establish a system that safeguards both patients and donors, then it'll be of huge benefit for everyone. And we're well on the way to doing that," says Hvas.

The study was conducted in collaboration with the Department of Business and Management at Aalborg University.

Source: Aarhus University

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