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

// Ting Zhang 1, * , Jie Xiang 1, * , Bota Cui 1 , Zhi He 1 , Pan Li 1 , Hai Chen 2 , Lijuan Xu 1 , Guozhong Ji 1 , Yongzhan Nie 3 , Kaichun Wu 3 , Daiming Fan 3 , Guangming Huang 1, ** , Jianling Bai 4, ** and Faming Zhang 1, ** 1 Medical Center for Digestive Diseases, The Second Affiliated Hospital of Nanjing Medical University, Nanjing 210011, China 2 Center for Disease Control and Prevention, Wuxi 214000, China 3 State Key Laboratory of Cancer Biology and Xijing Hospital of Digestive Diseases, The Fourth Military Medical University, Xi’an 710032, China 4 Department 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.