The ongoing challenge of Clostridioides difficile infection in Austria: economic evaluation of two recommended treatment pathways.

Authors

Evelyn Walter, Marco Voit, Gerald Eichhober, Gordon Spencer, Lei Wang, Vanessa Stadlbauer

Published in

Journal of medical economics. Volume 29. Issue 1. Pages 2186-2200. Epub Aug 19, 2026.

Abstract

Clostridioides difficile (CD) is a major nosocomial pathogen causing severe and potentially life-threatening infections, particularly following disruption of gut microbiota. Transmission occurs via resilient spores through the fecal-oral route. While most infections originate in hospitals or long-term care facilities, 20-30% are community-acquired. In Austria, national surveillance data report 769 severe CDI cases in 2024, indicating a substantial disease burden. This analysis compares two treatment scenarios: (1) the pathway recommended by the Austrian Society of Gastroenterology and Hepatology (ÖGGH), which designates fidaxomicin as first-line therapy and reflects its reimbursement under the national reimbursement-code (positive list) as of December 2025, and (2) clinical practice prior to reimbursement, when the use of fidaxomicin was restricted by reimbursement constraints (reference pathway).
A decision-tree model simulated CDI treatment. Patients could receive up to three successive therapies per episode and experience up to two recurrences. Treatment duration was fixed for 10 days. Inputs-patient characteristics, response rates, recurrence risk, utilities, CDI-related mortality, and costs (2025€)-were sourced from literature and validated by clinical experts. The model was evaluated over a lifetime horizon from the perspective of the Austrian healthcare system. Deterministic and probabilistic sensitivity-analyses tested robustness.
Average lifetime costs per patient were 4,026.86€for the ÖGGH pathway and 4,082.90€for the reference pathway, yielding incremental savings of -56.04€. Higher treatment costs (+234.29€) were offset by reduced downstream costs (-290.33€). The ÖGGH strategy improved outcomes, with 0.12 additional QALYs (7.01 vs. 6.89) and 0.20 life years gained (10.75 vs. 10.55), resulting in a dominant incremental cost-utility ratio (-478.25€/QALY).
Fidaxomicin reimbursement is the dominant strategy and supports implementation of the ÖGGH guideline in Austria.

PMID:
42619425
Bibliographic data and abstract were imported from PubMed on 20 Aug 2026.

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